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Metabolic syndrome and collateral vessel formation in patients with documented occluded coronary arteries: association with hyperglycaemia, insulin-resistance, adiponectin and plasminogen activator inhibitor-1.

Mouquet F, Cuilleret F, Susen S, Sautière K, Marboeuf P, Ennezat PV, McFadden E, Pigny P, Richard F, Hennache B, Vantyghem MC, Bertrand M, Dallongeville J, Jude B, Van Belle E - Eur. Heart J. (2009)

Bottom Line: The metabolic syndrome (MS) is associated with an increased cardiovascular risk.MS was associated with less developed collateral vessels (P = 0.005).This association is partly related to fasting glycaemia and to key parameters linked to insulin resistance.

View Article: PubMed Central - PubMed

Affiliation: Departments of Cardiology, Centre Hospitalier Régional Universitaire, Lille, France.

ABSTRACT

Aims: The metabolic syndrome (MS) is associated with an increased cardiovascular risk. Patients with the MS have endothelial dysfunction, decreased circulating adiponectin, and a high expression of angiogenic inhibitors such as plasminogen activator inhibitor-1 (PAI-1). We hypothesized that such patients, in the event of a coronary occlusion, might exhibit a less developed collateral circulation.

Methods and results: Three hundred and eighty-seven consecutive patients with at least one coronary occlusion of a major coronary vessel at diagnostic angiography were prospectively enrolled. Collateral development was graded with validated angiographic methods. The MS was defined according to the ATP-III definition. Fasting glucose, adiponectin, insulin concentrations, and PAI-1 were measured at the time of angiography. MS was associated with less developed collateral vessels (P = 0.005). In multivariable analysis adjusting for potential confounding factors including the duration of coronary occlusion (P = 0.0001), fasting glycaemia (P = 0.0007), low adiponectin concentration (P = 0.01), insulin-resistance (HOMA-IR; P = 0.01), high circulating PAI-1 concentration (P = 0.01), and hypertension (P = 0.008) were independently associated with poor coronary collateral vessel development.

Conclusion: This study shows that in patients with coronary occlusion, collateral circulation is impaired in patients with the MS. This association is partly related to fasting glycaemia and to key parameters linked to insulin resistance.

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Effect of the number of components of the metabolic syndrome on the ‘collateral flow grade’ (A; P = 0.0005) and on the number of circulating ‘early endothelial progenitor cells’ (B; P = 0.005).
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EHN569F2: Effect of the number of components of the metabolic syndrome on the ‘collateral flow grade’ (A; P = 0.0005) and on the number of circulating ‘early endothelial progenitor cells’ (B; P = 0.005).

Mentions: In univariable analyses, MS was associated with a lower grade of collateral flow (P = 0.005, Table 3). The collateral flow grade was inversely correlated to the number of components of the MS (P = 0.002), high blood pressure (P = 0.04), fasting glycaemia >6.1 mmol/L (P = 0.002), insulin concentration (P = 0.04), HOMA-IR (P = 0.03), and PAI-1 concentration (P = 0.02) and positively correlated to adiponectin concentration (P = 0.001). In order to further assess the relationship between coronary collateral flow grade and the MS, multivariable analyses were performed (Table 4). First, the association between the MS and collateral flow grade was assessed by using the MS as a quantitative data (from 0 to 5 according to the number of components of the MS) in a model adjusted for potential confounding factors (age, sex, smoking, total cholesterol, time since coronary occlusion, clinical symptoms, use of ACE-inhibitors, use of statins, and number of diseased coronary vessels). In this model, the MS was associated with a lower collateral flow grade (P = 0.0003, Model 1; Table 4, Figure 2). Similar results were observed when the MS was entered as a qualitative data (yes vs. no, β =−381; P = 0.001) adjusted for the same confounding factors. Finally, as an alternative to MS, the relation between individual components of the MS (high blood pressure, hypertriglyceridaemia, low HDL cholesterol, high fasting glucose, obesity, HOMA-IR, adiponectin, and PAI-1), and collateral flow grade was assessed. High fasting glycaemia (P = 0.0007), high blood pressure (P = 0.008), HOMA-IR (P = 0.01), adiponectin (P = 0.01), and PAI-1 (P = 0.01) were significantly associated with collateral flow grade (Model 2, Table 4). Similar associations were observed when analyses were restricted to patients with only one coronary occlusion (data not shown).


Metabolic syndrome and collateral vessel formation in patients with documented occluded coronary arteries: association with hyperglycaemia, insulin-resistance, adiponectin and plasminogen activator inhibitor-1.

Mouquet F, Cuilleret F, Susen S, Sautière K, Marboeuf P, Ennezat PV, McFadden E, Pigny P, Richard F, Hennache B, Vantyghem MC, Bertrand M, Dallongeville J, Jude B, Van Belle E - Eur. Heart J. (2009)

Effect of the number of components of the metabolic syndrome on the ‘collateral flow grade’ (A; P = 0.0005) and on the number of circulating ‘early endothelial progenitor cells’ (B; P = 0.005).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2663725&req=5

EHN569F2: Effect of the number of components of the metabolic syndrome on the ‘collateral flow grade’ (A; P = 0.0005) and on the number of circulating ‘early endothelial progenitor cells’ (B; P = 0.005).
Mentions: In univariable analyses, MS was associated with a lower grade of collateral flow (P = 0.005, Table 3). The collateral flow grade was inversely correlated to the number of components of the MS (P = 0.002), high blood pressure (P = 0.04), fasting glycaemia >6.1 mmol/L (P = 0.002), insulin concentration (P = 0.04), HOMA-IR (P = 0.03), and PAI-1 concentration (P = 0.02) and positively correlated to adiponectin concentration (P = 0.001). In order to further assess the relationship between coronary collateral flow grade and the MS, multivariable analyses were performed (Table 4). First, the association between the MS and collateral flow grade was assessed by using the MS as a quantitative data (from 0 to 5 according to the number of components of the MS) in a model adjusted for potential confounding factors (age, sex, smoking, total cholesterol, time since coronary occlusion, clinical symptoms, use of ACE-inhibitors, use of statins, and number of diseased coronary vessels). In this model, the MS was associated with a lower collateral flow grade (P = 0.0003, Model 1; Table 4, Figure 2). Similar results were observed when the MS was entered as a qualitative data (yes vs. no, β =−381; P = 0.001) adjusted for the same confounding factors. Finally, as an alternative to MS, the relation between individual components of the MS (high blood pressure, hypertriglyceridaemia, low HDL cholesterol, high fasting glucose, obesity, HOMA-IR, adiponectin, and PAI-1), and collateral flow grade was assessed. High fasting glycaemia (P = 0.0007), high blood pressure (P = 0.008), HOMA-IR (P = 0.01), adiponectin (P = 0.01), and PAI-1 (P = 0.01) were significantly associated with collateral flow grade (Model 2, Table 4). Similar associations were observed when analyses were restricted to patients with only one coronary occlusion (data not shown).

Bottom Line: The metabolic syndrome (MS) is associated with an increased cardiovascular risk.MS was associated with less developed collateral vessels (P = 0.005).This association is partly related to fasting glycaemia and to key parameters linked to insulin resistance.

View Article: PubMed Central - PubMed

Affiliation: Departments of Cardiology, Centre Hospitalier Régional Universitaire, Lille, France.

ABSTRACT

Aims: The metabolic syndrome (MS) is associated with an increased cardiovascular risk. Patients with the MS have endothelial dysfunction, decreased circulating adiponectin, and a high expression of angiogenic inhibitors such as plasminogen activator inhibitor-1 (PAI-1). We hypothesized that such patients, in the event of a coronary occlusion, might exhibit a less developed collateral circulation.

Methods and results: Three hundred and eighty-seven consecutive patients with at least one coronary occlusion of a major coronary vessel at diagnostic angiography were prospectively enrolled. Collateral development was graded with validated angiographic methods. The MS was defined according to the ATP-III definition. Fasting glucose, adiponectin, insulin concentrations, and PAI-1 were measured at the time of angiography. MS was associated with less developed collateral vessels (P = 0.005). In multivariable analysis adjusting for potential confounding factors including the duration of coronary occlusion (P = 0.0001), fasting glycaemia (P = 0.0007), low adiponectin concentration (P = 0.01), insulin-resistance (HOMA-IR; P = 0.01), high circulating PAI-1 concentration (P = 0.01), and hypertension (P = 0.008) were independently associated with poor coronary collateral vessel development.

Conclusion: This study shows that in patients with coronary occlusion, collateral circulation is impaired in patients with the MS. This association is partly related to fasting glycaemia and to key parameters linked to insulin resistance.

Show MeSH
Related in: MedlinePlus