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Table 2 presents the data when only the 704 patients with high-risk plaques were considered (326 in the MS group and 378 in the non-MS group). 288) and gender (P = 0.577) between the two Green Sites dating service groups. Pharmacological treatment of hypertension (P = 0.501), diabetes(P = 0.069), hyperlipidemia(P = 0.132), aspirin (P = 0.112), and statins (P = 0.231) also showed no significant difference between the two groups. The hsCRP levels in the MS group were significantly higher than those in the non-MS group, and the differences were statistically significant (8.0 ± 2.7 mg/l vs. 7.1 ± 3.2 mg/l, P<0.001). In terms of the imaging characteristics of high-risk plaques in the two groups, the ratio of positive remodeling, spot-like calcification and napkin ring signs in the MS group were significantly higher than that in the non-MS group, and the difference was statistically significant (66.3% vs. 54.2%, P = 0.001; 65.3% vs 54.8%, P = 0.004; 50.6% vs. 40.7%, P = 0.010).
All the patients were followed up by telephone and outpatient service for 36 months. All Patients were encouraged to practice heart-healthy lifestyle behaviors , including: (1) Consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts; (2) Limits intake of sodium, sweets, sugar-sweetened beverages, and red meats. (3) Counseling to reduce sodium intake by an average of 1150 mg/d. Engage in 2 h and 30 min per week of moderate-intensity physical activity. With a loss rate of 6.1%, 30 patients in the MS group and 48 patients in the non-MS group were lost to follow-up. Finally, 144 patients in the MS group had MACEs during the follow-up period (27.5%), while 76 patients in the non-MS group had MACEs during the follow-up period (11.7%), and the difference was statistically significant (P < 0.001). For those who had high risk plaques, 96 patients in the MS group had MACEs during the follow-up period (29%), while 57 patients in the non-MS group had MACEs during the follow-up period (15%), and the difference was statistically significant (P < 0.001). (Tables 1 and 2).
The proportional hazard assumption was checked by the Schoenfeld residual global test, and there was no breach of that hypothesis (P = 0.159). Variance inflation factors were all < 4.0 indicated that there exist no significant interactions between the variables (Table 1). In the whole population, MS (HR = 2.128, 95%CI: 1.524–2.970, P < 0.001), presence of high-risk plaques (HR = , 95%CI: 7.749–, P < 0.001) and hsCRP (HR = 1.629, 95%CI: 1.128–2.352, P = 0.009) were related to an increased risk of MACEs in patients with risk factors for coronary heart disease. Of the metabolic syndrome components, abdominal obesity (HR = 1.264, 95%CI:0.823–0.908, P = 0.033), hyperglycemia (HR = 1.567, 95%CI:1.096–2.639, P = 0.015), high blood pressure (HR = 1.700, 95%CI:0.297–0.728, P = 0.018) and hyperlipidemia (HR = 1.634, 95%CI:0.431–0.933, P = 0.021) were related to an increased risk of MACEs at 36 months. (Table 3).
Adjusted for statistically significant variables in Table 2 such as age, sex, BMI, waist circumference, HDL, TG, FBG, hsCRP, positive remodeling, spotty calcification, napkin ring sign, MS (HR = 2.265, 95%CI: 1.629–3.150, P < 0.001) and hsCRP (HR = 1.267, 95%CI: 1.191–1.348, P = 0.004) remained independent risk factors for MACEs in patients with high-risk coronary plaques at 36 months. Of the metabolic syndrome components, abdominal obesity (HR = 1.526, 95%CI:1.118–2.082, P = 0.008), hyperglycemia (HR = 1.640, 95%CI:0.460–0.890, P = 0.003) and high blood pressure (HR = 1.405, 95%CI:0.264–0.620, P < 0.001) were related to an increased risk of MACEs. (Table 4). We also tested the proportional hazard assumption by using Schoenfeld residual test and found no breach of that hypothesis (P = 0.116); Variance inflation factors were all < 4.0 so that there exist no significant interactions between the variables. (Table 2) Fig. 2 shows the number of patients with and without high-risk plaques according to the number of components of the metabolic syndrome they exhibited. As the number of MS components increased, the ratio of patients with high-risk plaques increased relative to the number without high-risk plaques.