How deadly is the "deadly quartet"? A post-CABG evaluation

OBJECTIVES The aim of the study was to determine the value of a cluster of metabolic risk factors in predicting mortality after coronary artery bypass surgery (CABG). BACKGROUND The "deadly quarter" of metabolic risk factors (i.e., obesity, d iabetes, hypertension, and hypertriglyceridemia) has been associated with c oronary heart disease in healthy population studies. The expected influence of the cluster on survival in secondary prevention remains untested overal l as well as by gender. METHODS Patients with lipid profiles undergoing primary isolated CABG (n = 6,428) between 1987 and 1992 were followed a median of eight years. Cox mod els were used to evaluate all-cause mortality. Metabolic risk factors were incorporated as the sum of deadly quarter risk factors present in each pati ent (0 to 4). The role of gender as it relates to survival and metabolic ri sk clusters tvas also examined. RESULTS The sum of deadly quartet risk factors showed a significant relatio nship to mortality as the hazard ratio increased from 1.64 (confidence inte rval [CI] = 1.34-2.01) for one risk factor to 3.95 (2.73-5.69) for four ris k factors. Annualized mortality ranged from 1% per year in patients with no risk factors to 3.3% per year in patients with all four risk factors. With in gender, the hazard ratio associated with four risk factors was 2.58 for men and 13.39 for women. The expected clustering of risk factors was 8% com pared to the observed clustering of 10% in men and 21% in women. CONCLUSIONS This cohort showed risk factor clustering beyond that expected due to chance, particularly in women. Even after revascularization, surviva l is diminished for patients with members of a family of metabolic risk fac tors at the time of surgery. (J Am Coil Cardiol 2000;36:1159-65) (C) 2000 b y the American College of Cardiology.