Metabolic syndrome definitions and components in predicting major adverse cardiovascular events after kidney transplantation

Abstract

SummaryMetabolic syndrome (MetS) associates with cardiovascular risk post-kidney transplantation, but its ambiguity impairs understanding of its diagnostic utility relative to components. We compared five MetS definitions and the predictive value of constituent components of significant definitions for major adverse cardiovascular events (MACE) in a cohort of 1182 kidney transplant recipients. MetS definitions were adjusted for noncomponent traditional Framingham risk factors and relevant transplant-related variables. Kaplan-Meier, logistic regression, and Cox proportional hazards analysis were utilized. There were 143 MACE over 7447 patient-years of follow-up. Only the World Health Organization (WHO) 1998 definition predicted MACE (25.3 vs 15.5 events/1000 patient-years, P = 0.019). Time-to-MACE was 5.5 AE 3.5 years with MetS and 6.8 AE 3.9 years without MetS (P < 0.0001). MetS was independent of pertinent MACE risk factors except age and previous cardiac disease. Among MetS components, dysglycemia provided greatest hazard ratio (HR) for MACE (1.814 [95% confidence interval 1.26-2.60]), increased successively by microalbuminuria (HR 1.946 [1.37-2.75]), dyslipidemia (3.284 [1.72-6.26]), hypertension (4.127 [2.16-7.86]), and central obesity (4.282 [2.09-8.76]). MetS did not affect graft survival. In summary, although the WHO 1998 definition provides greatest predictive value for posttransplant MACE, most of this is conferred by dysglycemia and is overshadowed by age and previous cardiac disease.

Diabetes mellitus, hypertension and frailty: A population‐based, cross‐sectional study of Mexican older adults

“…Diabetes and hypertension are two of the most frequent chronic diseases in older adults, and also are the most common causes for hospitalization and mortality; this is more evident in populations where high rates of obesity are found, such as the Mexican population. In addition, diabetes is associated with a higher risk of multiple coexisting medical conditions and geriatric syndromes in older persons . In contrast, hypertension is a chronic disease with a slow and silent evolution; persons might not be aware of their condition before a related major event occurs .…”

“…In contrast, hypertension is a chronic disease with a slow and silent evolution; persons might not be aware of their condition before a related major event occurs . Both conditions are associated with micro‐ and macrovascular complications, which eventually could lead to dependency, increased need for long‐term care use and death, a similar path to that of frailty.…”

Center variation in screening for and management of metabolic syndrome in pediatric liver transplant recipients: A survey of SPLIT centers

“…To optimize outcomes in pediatric liver transplant recipients, attention to chronic medical conditions that impact long‐term morbidity is crucial. PTMS—a clustering of hypertension, dyslipidemia, glucose intolerance, and increased waist circumference that can occur with or without obesity—is increasingly recognized as a significant contributor to long‐term morbidity and mortality after solid‐organ transplantation . In adults after liver transplant, these conditions are associated with long‐term cardiovascular morbidity and mortality …”

“…PTMS-a clustering of hypertension, dyslipidemia, glucose intolerance, and increased waist circumference that can occur with or without obesity-is increasingly recognized as a significant contributor to long-term morbidity and mortality after solid-organ transplantation. 1,2 In adults after liver transplant, these conditions are associated with long-term cardiovascular morbidity and mortality. 3,4 We have recently shown that pediatric liver transplant recipients have a higher risk of pre-hypertension and hypertension, impaired glucose tolerance (pre-diabetes), and low HDL than matched peers, even after controlling for obesity and corticosteroid use.…”

Interleukin‐2 receptor antagonists: Protective factors against new‐onset diabetes after renal transplantation

“…2 In addition, newonset diabetes after transplantation (NODAT), which is a common complication of renal transplantation, is associated with increased rates of long-term complications, including cardiovascular diseases, malignancy, and infections, all of which lead to higher morbidity and mortality rates. 3 Therefore, the long-term outcomes and quality of life of RTRs have started attracting the attention of the research community in recent years.…”