Impact of metabolic syndrome on coronary plaque vulnerability in Japanese women with acute coronary syndrome

Background Previous study has demonstrated that metabolic syndrome (MetS) can predict cardiovascular mortality in men, but the prediction was weak for women. In the present study predictors for multiple complex coronary lesions were investigated to clarify the impact of MetS in Japanese women with acute coronary syndrome (ACS). Methods and Results Subjects were Japanese women with ACS (n=81) who underwent emergency coronary angiography and B-mode carotid ultrasonography. They were divided into 2 groups based on the number of complex plaques. Although the MetS prevalence identified using the Japanese criteria was similar between the 2 groups, using the modified ATP III criteria it was more in patients with multiple coronary lesions than in those with a single coronary lesion (p<0.02). The prevalence of diabetes mellitus (DM) in the multiple group was higher than that in the single group (p<0.008). Significant independent predictors for multiple complex coronary lesions were DM (odds ratio (OR) 4.78, p<0.03) and carotid artery remodeling (OR 8.81, p<0.02). Among the components of MetS, a low level of high-density lipoprotein-cholesterol (<50mg/dl) was a significant independent predictor (p<0.007). Conclusions DM and carotid artery remodeling are useful markers for coronary vulnerability in Japanese women. Gender-specific pathophysiological differences may exist for components of MetS.