NEW YORK (Reuters Health) – The mortality risk associated with heart failure is increased in indigent patients with comorbid metabolic syndrome, new study findings indicate.

“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,” Dr. Leonardo Tamariz and co-investigators report in the June issue of Clinical Cardiology.

To investigate, Dr. Tamariz, from the University of Miami in Florida, and his team analyzed data for individuals enrolled in a heart failure disease management program in a rural public hospital that primarily serves an indigent population.

Included were 865 consecutive heart failure patients with left ventricular ejection fraction less than 40%, treated at the hospital between 1999 and 2003. Treatment was based on “a simple, structured treatment protocol” to decrease practice variation and improve guideline adherence.

Forty percent of the subjects had metabolic syndrome, the report indicates.

During a mean follow-up of 2.6 years, more patients with metabolic syndrome died than those without metabolic syndrome (24% vs 16%, p < 0.01). After adjustment for sociodemographics, clinical factors, medications, and baseline ejection fraction, the relative hazard of death form the metabolic syndrome group was 1.5 compared with the control group. The authors suggest that sympathetic activation, which occurs in both heart failure and metabolic syndrome, may explain the excess mortality in patients with both conditions. Among the individual components of metabolic syndrome, elevated fasting blood glucose levels and lower HDL-cholesterol were the main determinants of influencing mortality risk, Dr. Tamariz and associates observe. This effect on mortality risk was independent of the Framingham risk score.” They conclude: “Physicians treating patients with heart failure need to address the current metabolic syndrome epidemic in heart failure.” Reference:
Clin Cardiol 2009;32:327-331.