Metabolic syndrome in young Asian Indian patients with myocardial infarction

OBJECTIVES: This study assessed the prevalence of the metabolic syndrome and its impact on hospital outcomes in young South African Indians (≤ 45 years) with acute myocardial infarction (AMI) using both the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) and the International Diabetes Federation (IDF) definitions. METHODS AND RESULTS: The study population comprised 389 patients with AMI. The metabolic syndrome as defined by the NCEP ATP III criteria was found in 235 (60%) patients and in 223 (57%) according to the IDF criteria, with only a 79% concordance between the two definitions. However, when ethnic-specific waist circumference cut-offs proposed by the IDF were used as a criterion for obesity in the NCEP ATP III definition, the number of patients with the metabolic syndrome increased significantly to 270 (69%) (p < 0.001). Elevated fasting blood glucose was the major NCEP ATP III determinant present in 86% of individuals. All determinants for both definitions were found more frequently in patients with the metabolic syndrome (p < 0.001). Although 44% of patients had triple-vessel disease on cardiac catheterisation studies, the frequency of adverse cardiovascular events during hospital stay was low, and was uninfluenced by the presence or absence of the metabolic syndrome. CONCLUSION: The metabolic syndrome is a common finding in young Indian patients with AMI who frequently present with extensive atherosclerotic disease. Adverse event rate during hospital stay was low, and was unrelated to the presence of the metabolic syndrome. There was no significant difference in the prevalence rate of the metabolic syndrome as determined by either the NCEP ATP III or IDF definitions, but there was only a moderate level of agreement between the two definitions. Inclusion of ethnic-specific waist circumference cut-offs as the determinant of obesity in the NCEP definition may identify more accurately individuals at increased cardiometabolic risk and improve predication of the metabolic syndrome.