Korean Circ J.  2019 Aug;49(8):691-708. 10.4070/kcj.2019.0187.

Metabolic Syndrome in Adult Congenital Heart Disease

• Niwa K

• KMID: 2456864
• DOI: http://doi.org/10.4070/kcj.2019.0187

Abstract

In adult congenital heart disease (ACHD), residua and sequellae after initial repair develop late complications such as cardiac failure, arrhythmias, thrombosis, aortopathy, pulmonary hypertension and others. Acquired lesions with aging such as hypertension, diabetes mellitus, obesity can be negative influence on original cardiovascular disease (CVD). Also, atherosclerosis may pose an additional health problem to ACHD when they grow older and reach the age at which atherosclerosis becomes clinically relevant. In spite of the theoretical risk of atherosclerosis in ACHD due to above mentioned factors, cyanotic ACHDs even after repair are noted to have minimal incidence of coronary artery disease (CAD). Acyanotic ACHD has similar prevalence of CAD as the general population. However, even in cyanotic ACHD, CAD can develop when they have several risk factors for CAD. The prevalence of risk factor is similar between ACHD and the general population. Risk of premature atherosclerotic CVD in ACHD is based, 3 principal mechanisms: lesions with coronary artery abnormalities, obstructive lesions of left ventricle and aorta such as coarctation of the aorta and aortopathy. Coronary artery abnormalities are directly affected or altered surgically, such as arterial switch in transposition patients, may confer greater risk for premature atherosclerotic CAD. Metabolic syndrome is more common among ACHD than in the general population, and possibly increases the incidence of atherosclerotic CAD even in ACHD in future. Thus, ACHD should be screened for metabolic syndrome and eliminating risk factors for atherosclerotic CAD.

Keyword

Adult congenital heart disease; Metabolic syndrome; Cardiovascular diseases; Coronary artery disease; Cyanotic congenital heart disease

MeSH Terms

Adult*
Aging
Aorta
Aortic Coarctation
Arrhythmias, Cardiac
Atherosclerosis
Cardiovascular Diseases
Coronary Artery Disease
Coronary Vessels
Diabetes Mellitus
Heart Defects, Congenital*
Heart Failure
Heart Ventricles
Humans
Hypertension
Hypertension, Pulmonary
Incidence
Obesity
Prevalence
Risk Factors
Thrombosis

Figure

• 

  Figure 1 Prevalence of metabolic syndrome. Metabolic syndrome was observed in 16% adult congenital disease patients, on the contrary, metabolic syndrome in the general population in Japan was 5.5%. When any 3 of these are observed, metabolic syndrome is defined: 1) Waist circumference: >85 cm 2) Triglycerides: ≥150 mg/dL (1.7 mmol/L)* 3) High-density cholesterol: ≤40 mg/dL (1.0 mmol/L) in males and ≤50 mg/dL (<1.3 mmol/L) in females* 4) Systolic blood pressure ≥130 and/or diastolic blood pressure >85 mmHg* 5) Fasting blood sugar: ≥100 mg/dL* *Drug treatment for the specific condition is an alternate indicator.

• 

  Figure 2 Metabolic syndrome components. Waist circumference and blood pressure are higher in acyanotic ACHD comparing cyanotic ACHD. Triglycerides and fasting blood glucose are higher and HDL cholesterol is lower in cyanotic ACHD. Total number of patients, cyanotic ACHD, and acyanotic ACHD were 224 (age, 37.2±15.7; males, 45%; females, 55%), 105 (47%), and 117(53%). Definition of abnormal component is as follows; Increased waist circumference: >85 cm in male, >90 cm in female, elevated triglycerides: ≥150 mg/dL, low HDL cholesterol:<40 mg/dL, elevated blood pressure: >140/90 mmHg, elevated fasting glucose: 100 mg/dL. ACHD = adult conge natal heart disease; HDL, high-density lipoprotein.

• 

  Figure 3 Lipid profile. Lipid profile is not significantly different between cyanotic ACHD and acyanotic ACHD. Total number of patients, cyanotic ACHD, and acyanotic ACHD were 224 (age, 37.2±15.7; males, 45%; females, 55%), 105 (47%), and 117(53%). ACHD = adult conge natal heart disease; LDL = low-density lipoprotein; HDL = high-density lipoprotein.

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