Warnings regarding lipid management in cases of coronary artery disease and metabolic syndrome

What does "coronary artery disease equivalent risk" mean?

Coronary artery disease equivalent risk refers to patients who, without coronary artery disease, have the same risk of developing a major coronary artery event within 10 years as those with coronary artery disease. These patients should be treated with the same level of care as those already diagnosed with coronary artery disease. This category includes:

(1) Clinically manifested extracardiac atherosclerosis: This corresponds to the clinical conditions mentioned in the hypertension risk factors, such as ischemic stroke, peripheral artery disease, and transient ischemic attacks due to carotid atherosclerosis.

(2) Diabetes: The incidence of myocardial infarction in diabetic patients is basically the same as the probability of recurrent myocardial infarction in patients with a history of myocardial infarction, and the mortality rate after myocardial infarction is significantly higher than in non-diabetic patients.

(3) Patients with multiple risk factors: Their risk of developing cardiovascular events is equivalent to that of patients with established coronary artery disease.

What is Metabolic Syndrome?

Metabolic syndrome is a clinical syndrome characterized by obesity, hyperglycemia (impaired glucose regulation or diabetes), hypertension, and dyslipidemia [hypertriose and/or hypoHDL-C]. Its characteristic feature is the presence of interrelated metabolic risk factors in the same patient. These factors directly promote the development of ASCVD and increase the risk of type 2 diabetes. Evidence suggests that patients with metabolic syndrome are at high risk of cardiovascular disease. Compared to those without metabolic syndrome, their risk of developing cardiovascular disease and type 2 diabetes is significantly increased.

Currently, there is a general international consensus on the diagnostic criteria for hyperglycemia, hypertension, and dyslipidemia, which are components of metabolic syndrome. However, the diagnostic criteria for obesity, especially central obesity, a core indicator of metabolic syndrome, vary among different countries.

The diagnostic criteria for metabolic syndrome developed based on research in the Chinese population are the presence of three or more of the following criteria.

(1) Central obesity and/or abdominal obesity: Waist circumference ≥90 cm for men and ≥85 cm for women.

(2) Hyperglycemia: Fasting blood glucose ≥6.1 mmol/L (110 mg/dL) or 2-hour post-glucose load blood glucose ≥7.8 mmol/L (140 mg/dL) and/or diagnosed with and treated diabetes.

(3) Hypertension: Blood pressure ≥130/85 mmHg and/or diagnosed with and treated hypertension.

(4) Fasting triglycerides ≥1.7 mmol/L (150 mg/dL).

(5) Fasting HDL-C <1.0 mmol/L (40 mg/dL).

These factors directly promote the occurrence of ASCVD and also increase the risk of developing type 2 diabetes.