الفهرس 
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Abstract
CVD is becoming a major health burden in developing countries. In the year 2005,
58 million people died from CVD accounting for 30% of all deaths worldwide; more
than half these deaths were in developing countries1. If the risk factors associated with
CVD go unchecked, then by 2030, when the world population is expected to reach 8.2
billion, 33 percent (24.2 million) of all deaths will be due to CVD. In South Asia, which
represents more than a quarter of the developing world, a steady rise in incidence and
prevalence of this disease is already showing a dangerous trend in CVD bringing a great
challenge for health services.
Ever since the Framingham heart study in 1960s identified the important risk
factors associated with CAD, there has been a great stress to modify these risk factors to
reduce the burden of CVD. Among the conventional risk factors of CAD, modifiable
risk factors are diabetes, smoking, hypertension, hyperlipidemia, sedentary life style,
obesity stress and depression. Newly emerging risk factors include hsCRP,
homocysteine, lipoprotein (a), fibrinogen, D-dimers, Interleukin 6 and
myeloperoxidases.
MetSyn is a cluster of lipid and non lipid factors associated with insulin resistance
that places a subject at a higher risk for diabetes and cardiovascular events. According
to NCEP ATP-III and IDF criteria, the diagnosis of MetSyn be made when 3 or more of
the following characteristics are present: abdominal obesity, high FBS, high SBP, low
HDL-c, and high TG. MetSyn is associated with a greater risk of atherosclerotic disease
than any of its individual components. Insulin resistance is a central pathophysiological
process associated with MetSyn. Presence of MetSyn increases the risk of CVD twice in
next 5 to 10 years. It confers 5–fold increase in risk for developing type 2 DM.IDF and
NCEP ATP III identified CAD as the primary clinical outcome of the MetSyn.
In the present study 100 samples were collected randomly from C.C.U of
cardiology department of Menoufia university hospitals and EL-Mehalla Cardiac Center
from 1-2011 to 6-2011 with short term follow up for 6 month.
We classified them into 2 main groups, Group I patients with ACS having MetSyn
and Group II, patients with ACS without MetSyn
We found that 61 patients were fulfilled with criteria of MetSyn. 62.3% of patients
with MetSyn had acute STEMI. They were older in age without difference between
male and female. SBP and DBP level present in ACS patients with MetSyn is higher
than ACS patients with non MetSyn. SBP in patients of Group I (mean
136.721±17.699) vs Group II (mean 135.000±20.743), while DBP in patients of Group I
(mean 105.34 ±10.21) vs Group II (mean 90.31±6.51) both groups were diabetics but
FBS level in ACS patients with MetSyn (Group I) is higher than in patients with non
MetSyn (Group II) Group I (mean 248.590±66.465) vs Group II (mean
196.231±80.988). There is no difference in abdominal obesity between ACS patients
with MetSyn (Group I) and ACS patients with non MetSyn(Group II), Both were
overweight with slightly variation in their mean. Group I 27.508±2.357, Group II
26.359±1.967. ACS patients with MetSyn (Group I) have higher waist circumference
values (mean 97.918 ± 5.908).
TG level present in ACS patients with MetSyn (Group I) was higher than ACS
patients with non MetSyn (Group II) Group I (mean 140.016±39.160) vs Group II
(mean 120.051±44.606).
HDL level present in ACS patients with MetSyn (Group I) is lower than ACS
patients with non MetSyn (Group II) Group I (mean 29. 44±7.382) vs Group II (mean
45.846±8.902) .
39.34% of ACS patients with MetSyn had developed LSHF (killip classǁ) while
5.13%ACS patients with non MetSyn had developed LSHF. Both groups were nearly
equal in the incidenece of development of cardiogenic shock (killip class ІV) 9.84% in
Group I and 5.13% in Group II .
While an Echochardigraphy was done, in ACS patients with MetSyn (Group I), 23
patients from 61 developed higher evidence of depressed L.V. systolic function
[(7patients with mild (EF 45-55%) ,10 patients with moderate(EF 30-44%), 6 patients
with severe depressed systolic function(EF < 30%)] rather than ACS with non MetSyn
(Group II) [(4patients with mild (EF 45-55%) ,7 patients with moderate(EF 30-44%)
and 2patients with severe depressed systolic function(EF < 30%)].
We noticed in this study that from the five components of MetSyn, ACS patients
with MetSyn who developed LSHF tend to be diabetic (mean 264.923±58.598 with p
value 0.004)) with high TG levels (mean 145.615±44.689 with p value 0.035) and had a
high risk waist circumference for developing DMT2, HTN and heart disease (mean
97.308±6.967 with p value 0.006).while there is no significant of HDL levels,BMI or
SBP level on development of LSHF (p-value 0.696 , 0.303 and 0.305).
As we see, waist circumference,FBS levele and TG levels, each risk factor alone
was highly significant in the morbidity features(LSHF) of ACS patients with MetSyn.
While we found that when we done a regression analysis between these risk
factors together, the waist circumference alone was highly significant(P-value 0.007)
while the TG level and FBS levels were non significant at all(p-value 0.652, 0.083).
The present study reveals the high prevalence of the MetSyn in ACS cases,
particularly in older patients. Patients with MetSyn have high morbidity features. Of the
individual components of the MetSyn, FBS levels had the highest positive predictive
value in ACS cases and it was followed by high waist circumference levels and then
raised TG levels.