236 Prevalence of metabolic syndrome and insulin resistance in atherothrombotic disease in two modes of acute clinical presentation

Abstract

While there are much data on the risk factors involved in the onset of atherothrombotic stroke (AS) or acute coronary syndrome (ACS), few studies have compared the prevalence of metabolic syndrome (MS) and insulin resistance (IR) in the occurrence of these events. In a pilot study, prospective, comparative, single centre, 137 patients who presented an AS (N = 68) or ACS (N = 69) were consecutively included. The cardiovascular risk factors (CRF) were collected, the prevalence of MS was determined using « the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) and the International Diabetes Federation (IDF) definitions. IR was determined using the homeostasis model assessment of insulin resistance (HOMA-IR) in patients without insulin treatment. There were no significant differences between groups for history of hypertension or diabetes, cardiovascular heredity, body mass index, nor lipid parameters. Sex ratio was similar in both groups but AS patients were older (58.2 ± 8.4 vs. 54.0 ± 8.8 respectively, p = 0.006. Active smoking was more prevalent in the ACS group (30 vs. 18%, p = 0.04). Plasma glucose and insulin levels were higher in the ACS group (5.59 ± 1.86 vs. 5.0 ± 1.0 mmol/l, p = 0.04; 9. ±1.04 vs. 6.7 ± 3.6 μUI/ml, p = 0.04, respectively). There was no difference in the prevalence of MS between ACS and AS groups, using NCEP-ATPIII definition (11 vs. 12%, p = NS) or IDF definitions (26 vs. 23%, p = NS). There was a significantly higher IR in the ACS group (HOMA-IR 2.17+1.90 vs. 1.50+0.81, p = 0.03). In our study, distribution of cardiovascular risk factors is different according to the athero-thrombotic disease. The metabolic disturbances in particular IR seems to be predominant in the onset of ACS.