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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2006;26:189.)
© 2006 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Diabetes, the Metabolic Syndrome, and Angiographic Progression of Coronary Arterial Disease in Postmenopausal Women

Philip B. Mellen; William T. Cefalu; David M. Herrington

From the Department of Internal Medicine/Cardiology (P.B.M., D.M.H.), Wake Forest University School of Medicine, Winston-Salem, NC; and the Division of Nutrition and Chronic Diseases (W.T.C.), Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, La.

Correspondence to David M. Herrington, MD, MHS, Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail dherring{at}wfubmc.edu

Objective— Although the metabolic syndrome (MS) is associated with increased cardiovascular risk, its relationship with atherosclerotic progression is less well defined. We sought to determine whether the MS predicts angiographic progression of coronary heart disease in a cohort of postmenopausal women.

Methods and Results— A total of 309 postmenopausal women entered the Estrogen Replacement and Atherosclerosis trial, of whom 248 underwent baseline angiography and completed follow-up angiography after an average of 3.2 years. Women were identified as having type 2 diabetes mellitus (T2DM) or the MS (National Cholesterol Education Panel diagnostic criteria). In adjusted models, participants with T2DM and the MS had greater angiographic progression [change in minimal diameter (MD): –0.15] than women without T2DM or the MS (MD: –0.08; P<0.05) or with MS alone (MD: –0.07; P<0.005); there was no difference in progression by MS status in women without T2DM (P=0.54)]. In adjusted logistic regression models, T2DM predicted coronary heart disease events [odds ratio, 2.79 (95% CI, 1.29 to 6.02)], and the MS demonstrated a similar trend [odds ratio, 1.98 (95% CI, 0.90 to 4.33)].

Conclusions— Among postmenopausal women with coronary heart disease, the presence of diabetes predicted disease progression, but the MS did not.

Although the metabolic syndrome (MS) is associated with increased cardiovascular risk, its relationship with atherosclerotic progression is less well defined. We sought to determine whether the MS predicts angiographic progression of coronary heart disease in a cohort of postmenopausal women. Among postmenopausal women with coronary heart disease, the presence of diabetes predicted disease progression, but the MS did not.

Key Words: atherosclerosis • coronary angiography • metabolic syndrome • type 2 diabetes mellitus

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