Background: Metabolic syndrome (MS) refers to a clustering of factors that increases cardiovascular risk. There are at least 4 definitions of MS: International Diabetes Federation 2006 (IDF), World Health Organization 1999 (WHO), US National Cholesterol Education Program Adult Treatment Panel III 2001 (NCEP), and American Heart Association (AHA)/Updated NCEP 2004. The predictive ability of each definition for major adverse cardiac events (MACE) after kidney transplantation has not been compared.
Methods: After excluding patients with type 1 diabetes (N=30), we performed a 1998-2010 single-centre cohort study of 1182 adult single-organ kidney transplant recipients (KTR) followed to 6/30/2012. Demographics and pertinent cardiovascular risk and transplant-related variables were collected from a computerized database. MACE was defined as a composite of myocardial infarction, coronary revascularization, hospitalization for congestive heart failure, stroke, or cardiac death. Reports of angina were excluded. Measurements pertaining to MS definitions were obtained at 3 months post-transplant with MACE occurring prior to 3 months considered as previous cardiac disease. Pre-existing and new-onset diabetes were combined as a single variable. Events were adjudicated from 3 months post-transplant to 6/30/2012. MACE-free survival between MS and non-MS KTR by each definition was compared by Kaplan-Meier methodology and the log-rank test.
Results: For the entire cohort, age was 49 ± 13 y, 62% were male, 60% Caucasian, 15% smokers, 10% had DGF, 12% acute rejection, 62% were on hemodialysis pre-transplant, 71% on tacrolimus, and 18% had previous cardiac disease. Table 1 shows MACE rates by each MS definition.
|MS Definition||N||Years F/U||MACE||MACE Rate/100 patient years||P-value|
Conclusion: Among MS definitions, the WHO definition is the best predictor of MACE in KTR and can therefore be used to identify high-risk patients early post-transplant. Transplant programs should consider measuring parameters contained within the WHO definition such as waist and hip circumference and urine albumin excretion.
To cite this abstract in AMA style:Prasad G, Huang M, Silver S, Allawati A, Rapi L, Nash M, Zaltzman J. Comparative Ability of Different Metabolic Syndrome Definitions To Predict Major Adverse Cardiovascular Events after Kidney Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/comparative-ability-of-different-metabolic-syndrome-definitions-to-predict-major-adverse-cardiovascular-events-after-kidney-transplantation/. Accessed July 24, 2021.
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