Será a síndrome metabólica um marcador de prognóstico em doentes com elevado risco cardiovascular? Um estudo de coorte a longo‐prazo

Introduction: Obese patients are at higher cardiovascular risk in primary prevention. In secondary prevention, an obesity paradox has been reported. We analyzed a cohort of individuals from a previous cross‐sectional study on the impact of metabolic syndrome (MS) on coronary artery disease (CAD), aiming to assess the occurrence of cardiovascular events in a long follow‐up. Methods: We analyzed 296 individuals in a mean follow‐up of 6.9±2.2 years. Subjects were divided into four groups according to the presence of MS or CAD (defined as ≥70% coronary stenosis). Results: The study population had a mean age of 65±9 years at the beginning of the study; 59.5% were male, 55.7% had MS and 41.6% had CAD. During follow‐up 10.1% of the population suffered all‐cause death, 3.7% cardiovascular death, 14.2% cardiovascular readmission and 22.0% the composite outcome (mortality, acute coronary syndrome, coronary revascularization, stroke/transient ischemic attack or heart failure admission). There were no significant differences in any type of mortality. Patients with CAD had more readmissions and composite outcomes (log‐rank p<0.001 and p=0.001, respectively), but there was no difference according to the presence of MS. Only CAD was an independent predictor of cardiovascular admission (HR 3.21, 95% CI 1.66‐6.21) and composite outcomes (HR 2.41, 95% CI 1.44‐4.02). Conclusions: In patients with high cardiovascular risk or established CAD, the presence of MS is not associated with cerebral or cardiac events in long‐term follow‐up.