Original paper
Ischaemic heart disease and metabolic syndrome – correlation of selected risk factors of atherosclerosis with angiographic changes in coronary arteries

The coexistence of hypertension, insulin resistance, atherogenic dyslipidaemia and central obesity with hyperglycaemia is defined as metabolic syndrome (MS). It has been shown many times that MS is closely associated with the occurrence of ischemic heart disease (IHD) and cardiovascular complications. The presence of risk factors correlates with the progression of atherosclerotic lesions in coronary arteries, creating the potential of prevention. The importance of classic risk factors in the expansion of arteriosclerosis has been proved well. Homocysteine (Hcy) is a novel risk factor, and its role in atherosclerosis is a subject of interest and controversy.
Aim: The estimation of selected risk factors of arteriosclerosis in patients with IHD and coexistent MS.
Materials and methods: The study included 141 men aged upon 55 years old with coronarographically confirmed IHD without signs of renal insufficiency (GFR>60 ml/min). The advance of IHD was assessed due to the number of narrowed arteries ł50% and Duke index. Parameters of glucose metabolism, lipids, Hcy, folic acid and B12 vitamin were measured and classic risk factors were assessed in all patients. The presence or the absence of MS was a criterion of the division into 2 groups. MS signs were found in 57.4% patients. Results: Both subgroups were comparable in relation to baseline parameters besides MS criteria. In MS patients the advance of atherosclerosis correlated with Hcy, creatinine and GFR (p<0.05), but in non-MS patients with age (p=0.04). ROC curves indicated that Hcy concentration was a predictor of multivessel disease only in MS patients (cut-off point 10.85 µmol/l). Sensitivity and specificity were calculated respectively as 68.7% and 59.4%.
Conclusions: Among young men with IHD classic risk factors have basic importance, which is reflected by the frequency of MS. In MS patients Hcy concentration reveals an association with progression of atherosclerosis in coronary arteries and it can be a factor determining premature development. In these patients Hcy concentration above 10.85 µmol/l can indicate an increased risk of multivessel IHD.