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Metabolic Syndrome Predicts High Risk Status for Vascular Surgery
Trenton R. Foster, MD1, Go Kuwahara, MD, PhD1, Kota Yamamoto, MD, PhD1, Roland Assi, MD1, Clinton D. Protack, MD, PhD1, Michael R. Hall, MD1, Willis T. Williams, MD1, Penny Vasilas, RN2, Alan Dardik, MD, PhD1.
1Yale University School of Medicine, New Haven, CT, USA, 2VA Connecticut Healthcare System, West Haven, CT, USA.
OBJECTIVES:
Metabolic syndrome increases the risk of cardiovascular events in patients with peripheral vascular disease. However, the role of metabolic syndrome in predisposing towards postoperative complications after vascular surgery is poorly described. This study explores the effect of metabolic syndrome on adverse events after four commonly performed vascular surgical operations.
METHODS:
The records of patients who underwent carotid endarterectomy (CEA) performed between 2004-2008, arteriovenous fistula creation (AVF) from 1999-2009, lower extremity amputation from 2005-2010, or endovascular abdominal aortic aneurysm repair (EVAR) from 2003-2011 at a single institution were reviewed. An adverse event was defined according to operation and includes: re-stenosis > 50% after CEA, AVF primary failure < 6 mo, non-healing of the amputation site requiring operative revision, or development of endoleak any time after EVAR. Metabolic syndrome (MetS) was defined as three or more of the following: blood pressure ≥ 130/85 or on antihypertensive medication, serum triglycerides ≥ 150 mg/dl, HDL ≤ 40 mg/dl for men or ≤ 50 mg/dl for women, fasting blood glucose ≥ 110 mg/dl or on anti-hyperglycemic medication, or BMI ≥ 27 kg/m2.
RESULTS:
A total of 405 patients were included in the study. The average age was 69 years, 77% were white. Mean follow up was 3.9 years. 70% of patients had MetS. Baseline demographics were similar except that patients with MetS had statistically significant differences in mean triglyceride level of 198 vs 120 (p<0.0001), mean HDL level of 34 vs 48 (p<0.0001), hypertension was present in 97% vs 83% of patients (p<0.0001), diabetes present in 69% vs 22% (p 27 in 75% vs 19% of patients (p<0.0001). Patients with MetS had an increased rate of adverse events, 46% versus 36% (p=0.049, Chi-Square). Of all factors examined, logistic regression showed MetS to be the most predictive independent factor for adverse events (OR 1.99, p = 0.01) There was no statistical significance in overall survival between patients with and without MetS (p = 0.75 Log-rank).
CONCLUSIONS:
Metabolic syndrome is prevalent among patients undergoing vascular surgical operations. MetS is an independent risk factor for adverse events following these operations, suggesting that MetS is a factor identifying high risk patients after vascular surgery. Patients with MetS may require increased post operative surveillance or targeted treatment to reduce the rate of these events.
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