11. PMID: 35879153
Prevalence of Metabolic Syndrome in Young Adults With Congenital Heart Disease.
Umapathi KK, Thavamani A, Bosco G, Dhanpalreddy H, Nguyen HH.Am J Cardiol. 2022 Sep 15;179:90-95. doi: 10.1016/j.amjcard.2022.05.031. Epub 2022 Jul 22.PMID: 35879153
Take Home Points:
- Adults with congenital heart disease has an increased risk of developing metabolic syndrome
- The young adults have a higher risk of metabolic syndrome and its risk factors compared to the general population.
- When compared to normal controls, the risk of metabolic syndrome in descending order: Severe ACHD > Moderate ACHD > control.
Commentary from Dr. MC Leong (Kuala Lumpur), section editor of ACHD Journal Watch:
Adults with congenital heart disease (ACHD) have been shown in cohort studies to be at increased risk of developing metabolic syndrome (MetS), a cluster of metabolic abnormalities that increase the risk of cardiovascular disease and type 2 diabetes mellitus (1-3). Several factors have been implicated in the increased risk of MetS in ACHD, including activity restrictions, sedentary lifestyle, obesity and Fontan circulation (3,5).
This study aimed to study the prevalence of MetS in young adults aged 20-39 years in the United State using a large real-world population database. Patients were categorized into moderate and severe forms of ACHD based on ACHD anatomic and physiologic classification. As there were concerns of inaccuracies in the diagnosis of the mild form of ACHD, only moderate and severe forms of ACHD were analyzed. Diagnosis of MetS was made using a modified version of the International Diabetes Federation’s criteria.
In the study, the ACHD group was generally found to have a significantly higher risk of MetS (Table 3). Interestingly, the odds were higher in men and the 20-24 age group (Table 1). Tetralogy of Fallot and aortic arch anomalies were the most common CHD diagnoses in the ACHD group (Table 2). The severe ACHD group had a higher risk of MetS than the moderate ACHD group (Table 4, Figure 2). The ACHD group had higher odds of individual components of MetS, such as type 2 diabetes, family history of coronary artery disease, atrial fibrillation, obstructive sleep apnea, and pulmonary hypertension (Table 3). However, they had lower odds of risk factors for atherosclerotic cardiovascular disease, such as male sex, smoking, obesity, and chronic kidney disease. There was no significant difference in the prevalence of coronary artery disease between the ACHD and control groups.
Overall, the study highlights the importance of screening MetS in individuals with ACHD, particularly those with severe CHD and targeting risk factors for MetS in this population. Similar findings were found in a study with a similar study design, but with a smaller sample size (3). However, being a populational study, the study has its own flaws, for example, in the definitions of some of the variables, e.g. a high BMI does not equate to obesity. Also, the study provides data but is unable to explain some of the findings. For example, there was an unusually higher prevalence of MetS in the younger patients (age 20-24 years) in the cohort; and the finding of a higher prevalence of fasting hyperglycemia and a lower Type 2 diabetes in the ACHD group compared to control, all of which was not explainable in this study.
References:
1. Fyfe A, Perloff JK, Niwa K, Child JS, Miner PD. Cyanotic congenital heart disease and coronary artery atherogenesis. Am J Cardiol 2005;96:283–290.
2. Shin D, Kongpakpaisarn K, Bohra C. Trends in the prevalence of metabolic syndrome and its components in the United States 2007−2014.
3. Deen JF, Krieger EV, Slee AE, Arslan A, Arterburn D, Stout KK, Portman MA. Metabolic Syndrome in Adults With Congenital Heart Disease. J Am Heart Assoc. 2016 Feb 12;5(2):e001132.
4. Niwa K. Metabolic syndrome in adult congenital heart disease. Korean Circ J 2019;49:691–708.
5. Chung ST, Hong B, Patterson L, Petit CJ, Ham JN. High Overweight and Obesity in Fontan Patients: A 20-Year History. Pediatr Cardiol. 2016 Jan;37(1):192-200.
