Abstract 14197: Effects of Metabolic Syndrome on Arterial Responses to Drug-Eluting Stents: Obesity Paradox and Sex-Associated Differences
Background: The impact of metabolic syndrome (MetS) on the efficacy of drug-eluting stents (DES) remains controversial. This may be due in part to a positive influence of obesity (the “obesity paradox”) among the factors included in the definition of MetS. Fat distribution also varies by sex, possibly confounding the impact of obesity.
Methods: To elucidate the possible effects of obesity in MetS patients on neointimal hyperplasia, 575 patients treated with DES (sirolimus-, paclitaxel-, zotarolimus-, or everolimus-eluting stent) were stratified according to the presence of MetS with or without obesity, using NCEP-ATP III guidelines. Waist circumference or BMI were used for diagnosis of obesity. Follow-up IVUS was scheduled to obtain neointimal obstruction (%NIV: neointima / stent volumes), max cross-sectional narrowing (%CSN: neointima / stent areas), and IVUS-defined instent restenosis (ISR) defined as max %CSN>60%.
Results: By the standard criteria, 326 patients (56.7%) were diagnosed as MetS, and 279 patients (48.5%) met the criteria of obesity. Among the patients with MetS, 90 patients (27.6% of MetS patients) were categorized as non-obesity. At 8 months, %NIV, max %CSN, and IVUS-defined ISR rates were comparable between MetS and non-MetS. These parameters also showed no difference between obesity and non-obesity. In patients with MetS (Figure), however, neointimal hyperplasia was significantly greater in the absence of obesity in female patients, whereas no difference was observed in male patients. In multivariate analysis, non-obesity was an independent predictor for greater neointimal hyperplasia in female patients with MetS.
Conclusions: Overall, neither MetS nor obesity was related to neointimal hyperplasia within DES. In female MetS patients, however, comorbidity of obesity appeared to be paradoxically protective, possibly suggesting sex dependency of the obesity paradox.
- © 2013 by American Heart Association, Inc.