Prognostic impact of metabolic syndrome in patients with chronic heart failure: Data from GISSI-HF trial

• Risk of all-cause and HF death was reduced in patients with metabolic syndrome (METS) as compared with patients without METS.
• As compared with METS-/DM- subjects, risk of all-cause and HF death was significantly lower in METS+/DM- patients.
• As compared with METS-/DM- subjects, risk of all-cause and HF death was significantly increased in METS-/DM+ patients.
• METS+/DM+ patients showed no difference for risk of all-cause and HF death as compared with METS-/DM- subjects.

ObjectivesThe adverse prognostic impact of metabolic syndrome (METS) in unselected populations and in patients with coronary heart disease has been previously shown. The aim of the current analysis was to evaluate the impact of METS on prognosis in chronic heart failure (HF).MethodsInternational Diabetes Federation criteria were used for the diagnosis of METS. Adjusted Cox regression models with all-cause and HF death as outcomes were fitted in 6648 patients enrolled in GISSI-HF trial with no missing values for the variables of interest.ResultsRisk of all-cause and HF death was significantly reduced in patients with METS compared to patients without METS (HR: 0.83, 95% CI: 0.72 to 0.95, p = 0.005; HR: 0.76, 95% CI: 0.59 to 0.98, p = 0.031; respectively). As compared with patients with no METS and no type 2 diabetes mellitus (DM), the risk of all-cause and HF death was significantly lower in patients with METS and no DM (HR: 0.76, 95% CI: 0.62 to 0.95, p = 0.015; HR: 0.65, 95% CI: 0.42 to 0.99, p = 0.046; respectively), whereas it was significantly increased in patients with DM and no METS (HR: 1.34, 95% CI: 1.21 to 1.48, p < 0.001; HR: 1.44, 95% CI: 1.21 to 1.72, p < 0.001; respectively). Patients with METS and DM showed no difference for risk of total and HF death compared with patients with no METS and no DM (HR: 1.03, 95% CI: 0.87 to 1.21, p = 0.762; HR: 0.99; 95% CI: 0.73 to 1.35; p = 0.963; respectively).ConclusionsMETS is associated with reduced all-cause and HF mortality in patients with HF. HF patients with DM without METS are at the highest risk of mortality, whereas METS attenuates mortality risk in HF patients with DM.