Metabolic syndrome is an independent predictor of cardiovascular events in high-risk patients with occlusive and aneurysmatic peripheral arterial disease

Objective: Metabolic syndrome (MetSyn) is a well-known risk factor for cardiovascular (CV) disease in the general population; however, the additional predictive value for CV events in high-risk patients with peripheral arterial disease (PAD) is unknown. The aims of the current study were to assess and compare: (1) prevalence of MetSyn, and (2) predictive value of MetSyn for CV events, in patients with either occlusive or aneurysmatic PAD. Methods: We screened 2069 patients scheduled for lower occlusive arterial revascularization (n = 1031) or abdominal aortic aneurysm repair (n = 1038) for the presence of MetSyn. Adult Treatment Panel III report (ATP III) was used for de. ning MetSyn. Central obesity was defined as body-mass-index >30 kg/m(2). Main outcomes were the occurrence of CV events and CV mortality during a median follow-up of 6 years (IQR 2-9 years). Results: Metabolic syndrome was diagnosed in 421 (41%) and 432 (42%) patients with occlusive and aneurysmatic PAD, respectively (p = 0.72). Patients with occlusive or aneurysmatic PAD and MetSyn had an increased risk for the development of CV events, when compared to patients without MetSyn (27% vs. 18% and 27% vs. 19%, p < 0.001, respectively). In occlusive and aneurysmatic PAD, MetSyn was independently associated with an increased risk of CV events (HR = 1.6; 95% CI 1.2-2.1 and HR = 1.4; 95% CI 1.1-1.8). No significant association between the presence of MetSyn and CV mortality was observed. Conclusions: Metabolic syndrome is highly prevalent in high-risk PAD patients. In occlusive and aneurysmatic PAD patients, MetSyn is an independent predictor of long-term CV events. (C) 2009 Elsevier Ireland Ltd. All rights reserved.Vascular Biology and Interventio

Preoperative left ventricular dysfunction and temporary decline of renal function after vascular surgery predispose patients to increased long-term mortality

Cardiolog

The prevalence and prognostic implications of polyvascular atherosclerotic disease in patients with chronic kidney disease

Background. Atherosclerotic disease is often extended to multiple affected vascular beds (AVB). Polyvascular disease (PVD) and chronic kidney disease (CKD) have both separately been associated with an adverse cardiovascular outcome. We assessed the prevalence of PVD in vascular surgery patients with preoperative CKD and studied the influence on long-term cardiovascular survival. Methods. Consecutive patients (2933) were preoperatively screened for PVD, defined as 1-, 2- or 3-AVB. Preoperative glomerular filtration rate (GFR in ml/min/1.73 m(2) body-surface area) was estimated by the Modification of Diet in Renal Disease (MDRD) prediction equation, and patients were categorized according their estimated GFR. Primary end point was (cardiovascular) mortality during a median follow-up of 6.0 years (IQR 2-9). Results. Preoperative MDRD-GFR was classified as normal kidney function (GFR >= 90) or mild (GFR 60-89), moderate (GFR 30-59) and severe (GFR < 30) kidney disease in 779 (27%), 1423 (48%), 605 (21%) and 124 (4%) patients, respectively. One-vessel disease was present in 54% of the patients with normal kidney function, while 62% of the patients with CKD (GFR < 60) had PVD. In patients with moderate or severe kidney disease, the presence of PVD was independently associated with even higher cardiovascular mortality rates (2-AVB: HR 1.65 95%CI 1.09-2.48; 3-AVB: 2.07 95%CI 1.08-3.99), compared to 1-AVB. Conclusion. Patients with CKD had a high prevalence of PVD, which was independently associated with increased all-cause and cardiovascular mortality.Vascular Biology and Interventio

The prognostic implications of diastolic and systolic left ventricular dysfunction in patients with diabetes mellitus

Cardiolog

Repeated N-terminal pro B-type natriuretic peptide measurements as incremental predictor for long-term cardiovascular outcome after vascular surgery

Cardiolog