A new study found that heart failure in indigent patients with comorbid metabolic syndrome increases the risk of death.
Metabolic syndrome is a risk factor for diabetes, cardiovascular disease, and heart failure, but little is known about the impact of metabolic syndrome in patients who already have heart failure, told Dr. Leonardo Tamariz and co-investigators.
To study, Dr. Tamariz, from the University of Miami in Florida, and his colleagues analyzed data for individuals enrolled in a heart failure disease management program in a rural public hospital that primarily serves an indigent population.
The study involved 865 consecutive heart failure patients with left ventricular ejection fraction less than 40%, treated at the hospital between 1999 and 2003. To decrease practice variation and improve guideline adherence, the researchers implemented a simple, structured treatment protocol.
The report showed that 40% of the subjects had metabolic syndrome.
Over a mean follow-up of 2.6 years, patients with metabolic syndrome died more than those without metabolic syndrome (24% vs 16%, p < 0.01). The relative hazard of death in the metabolic syndrome group was 1.5 compared with the control group, after adjustment for sociodemographics, clinical factors, medications, and baseline ejection fraction.
According to the authors, sympathetic activation may explain the excess mortality in patients with both heart failure and metabolic syndrome.
The team found that among the individual components of metabolic syndrome, elevated fasting blood glucose levels and lower HDL-cholesterol were the main determinants of mortality risk. This effect on mortality risk did not depend on Framingham risk score.
They conclude: Physicians treating patients with heart failure need to address the current metabolic syndrome epidemic in heart failure.