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The Effects of Metabolic Syndrome Versus Infectious Burden on Inflammation, Severity of Coronary Atherosclerosis, and Major Adverse Cardiovascular Events

Cardiovascular Division (D.-F.D., C.-N.H., F.-T.C., J.-L.L., Y.-H.C., K.-L.H., C.-D.T., Y.-Z.T., J.-J.H.) and Gastroenterology Division (J.-H.K.), Department of Internal Medicine, and Department of Laboratory Medicine (F.-T.C.), National Taiwan University Hospital, Taipei 100, Taiwan; Graduate Institute of Clinical Medicine (J.-H.K.), College of Medicine, National Taiwan University, Taipei 100, Taiwan; and Cardiovascular Center of National Taiwan University Hospital, Yun-Lin Branch (J.-W.L., J.-J.H.), Dou-Liou City, Yun-Lin 640, Taiwan

Address all correspondence and requests for reprints to: Juey-Jen Hwang, M.D., Ph.D., Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan. E-mail: jueyhwang{at}ntu.edu.tw.

Background: The clinical predictors of inflammation in atherosclerosis remain controversial. The objective of this study was to compare the associations of metabolic factors vs. infectious burden (IB) with inflammation, the severity of coronary atherosclerosis, and major adverse cardiovascular events (MACEs).

Design, Setting, and Patients: Coronary angiography with Gensini score was applied to assess the severity of coronary atherosclerosis in 568 patients with coronary artery disease. Metabolic syndrome (MS) score (0–5) was defined according to the modified criteria of National Cholesterol Education Program Adult Treatment Panel III. IB score (0–7) was defined as the number of seropositivities to several agents.

Results: IB score was not associated with plasma C-reactive protein (CRP) concentration, Gensini score, or the risk of MACE. In contrast, MS score significantly correlated with both plasma CRP concentration and Gensini score (P < 0.001 for both). MS score and plasma CRP concentration were also significantly associated with the risk of MACE (hazard ratios 1.51, P < 0.001; and 1.90, P = 0.002, respectively).

Conclusion: Compared with IB, metabolic abnormalities have a more prominent association with the degree of inflammation, the severity of coronary atherosclerosis, and the risk of MACE in patients with coronary artery disease.