Arun, R (2006) A Study on the Prevalence and Impact of Metabolic Syndrome on Hospital Outcomes in Acute Myocardial Infarction. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Metabolic syndrome is a constellation of interrelated risk factors of metabolic origin – metabolic risk factors – that appear to directly promote the development of atherosclerotic cardio vascular disease and type 2 diabetes mellitus by two to three fold8. It has variously been referred as the insulin resistance syndrome. Insulin resistance is the key pathologic feature of the syndrome, since its components are either causes or consequences of impaired insulin action. The constellation of dyslipidemia (hypertriglyceridemia and low levels of highdensity lipoprotein cholesterol), elevated blood pressure, impaired glucose tolerance, and central obesity is identified now as metabolic syndrome.It is also a prothrombotic and proinflammatory state. Soon, metabolic syndrome will overtake cigarette smoking as the number one risk factor for heart disease . The National Cholesterol Education Program1-Adult Treatment Panel III has identified metabolic syndrome as an indication for vigorous lifestyle intervention. Studies based on populations at high risk for cardiovascular disease have shown a very high prevalence of metabolic syndrome. In this study the prevalence of metabolic syndrome in acute myocardial infarction and its impact on hospital outcomes like heart failure, length of ICCU stay, case fatality have been studied. The relative influence of each of the 5 components of NCEP ATP III definition of metabolic syndrome on various hospital outcomes like risk of death and heart failure was also studied. In this study, metabolic syndrome was defined according to the criteria of the National Cholesterol Education Program’s Adult Treatment Panel III (NCEPATP III). AIM OF THE STUDY: 1. To ascertain the prevalence of metabolic syndrome in acute myocardial infarction Patients. 2. To study the impact of metabolic syndrome on hospital outcomes, in particular, death and heart failure in acute myocardial infarction patients. 3. To assess the relative influence of each of the 5 components of NCEP ATP III definition of metabolic syndrome on the risk of death and heart failure. 4. To identify and treat the components of metabolic syndrome in acute myocardial infarction patients. SUBJECTS AND METHODS: Study Population: Patients admitted with acute myocardial infarction in Intensive Coronary Care unit in Government Stanley Hospital, between February, 2005 and February, 2006 constitute the study population. A total of 85 patients were studied. Patients were initially studied when they were in ICCU and they were followed up till their discharge. They were examined and investigated personally. The detailed clinical study was made as per proforma. The emphasis of this study is mainly to ascertain the prevalence of metabolic syndrome in acute MI patients and to study the impact of metabolic syndrome on hospital outcomes especially heart failure. The relatively influence of each of the components of metabolic syndrome was analysed. . No patient had been counted twice if he or she got admitted again after discharge during the period. Inclusion Criteria: 1. Patients admitted with acute ST elevation MI in ICCU. 2. All age groups were included. 3. Both sexes were included. Exclusion Criteria: Patients with non- STEMI, unstable angina were excluded. Diagnosis of Acute Myocardial Infarction: Acute STEMI was diagnosed based on typical chest pain, ECG showing ST elevation or new onset or suspected left bundle branch block as defined by the Joint Committee of the European Society of Cardiology and the American College of Cardiology. Diagnosis of Metabolic Syndrome: Metabolic syndrome was defined according to the AHA/NHLBI statement maintaining NCEP ATP III1 criteria with minor modifications. Patients received a diagnosis of metabolic syndrome if they had any 3 of the following 5 criteria: 1. Abdominal obesity (waist circumference > 90 cm in men and > 80 cm in women). 2. High triglyceride levels >=150mg/dL. 3. Low HDL Cholesterol level <40 mg/dL in men and <50 mg/dL in women. 4. High blood pressure (treated hypertension, systolic blood pressure >=130 mm Hg, or diastolic blood pressure >= 85 mm Hg). 5. Fasting glucose >= 100 mg/dL or on treatment for diabetes mellitus. CONCLUSION: 1. There is a high prevalence of metabolic syndrome in patients with acute myocardial infarction. 2. The prevalence of metabolic syndrome increases as age increases 3. In women, metabolic syndrome is more prevalent in older age. 4. All the components of metabolic syndrome namely hyperglycemia, abdominal obesity, hypertension, hypertriglyceridemia and low HDL levels showed statistical significance (p<0.05) confirming strong association with myocardial infarction. 5. Admission glucose was increased in both the groups and it did not show statistical significance with the metabolic syndrome group. 6. Though, total and LDL cholesterol were increased in both the groups, there was no significance. 7. Only two patients in the study gave a family history of CAHD and they showed metabolic syndrome but this was not significant statistically. 8. Metabolic syndrome group had a number of cardiovascular risk factors and history of previous MI. 9. Though smoking was more prevalent in the non-metabolic syndrome group there was statistical significance in the metabolic syndrome group (p=0.001). 10. Among the components of metabolic syndrome, hyperglycemia was associated more with heart failure. This confirms the importance of evaluating glycemic control during the acute phase of MI124. 11. Though recurrent MI (57.1%) and ventricular arrhythmias (77.8%) were more prevalent in the metabolic syndrome they did not show statistical significance in this study. 12. Heart failure was present more in metabolic syndrome group. The incidence of heart failure at admission was high and also during hospitalisation patients with metabolic syndrome developed severe heart failure (killip class > 2). It showed statistical significance. 13. Hyperglycemia was strongly associated in patients with severe heart failure. 14. Case fatality was high in MS group (2 patients died) than non MS group( one patient died) but this was not statistically significant. 15. The number of days in ICCU was high in the MS group when compared to NON-MS group and it was statistically significant.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Prevalence ; Impact ; Metabolic Syndrome ;n Hospital Outcomes ; Acute Myocardial Infarction |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 23 Mar 2018 02:28 |
| Last Modified: | 23 Mar 2018 02:28 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6434 |
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