RAPID COMMUNICATION Are Metabolic Syndrome and Its Components Associated with 5-Year Mortality in Chronic Obstructive Pupmonary Disease Patients? Suzana E. Tanni, MD, PhD, 1 Amanda T.S. Zamuner, MSc, 2 Liana S. Coelho, MD, 1 Simone A. Vale, MD, 1 Irma Godoy, MD, PhD, 1 and Sergio A.R. Paiva, MD, PhD 2 Abstract The aim of this study was to evaluate the risk of mortality according to the presence of metabolic syndrome in chronic obstructive pulmonary disease (COPD) patients who were followed for 5 years. We did not establish the influence of metabolic syndrome on mortality rate. However, an increase of 100 mg of triglycerides was associated with a 39% increase in the probability of death in the period of the study (hazard ratio 1.39, 95% confidence interval 1.06–1.83). T he presence of metabolic syndrome in chronic ob- structive pulmonary disease (COPD) patients has been studied previously, and its prevalence has been found to vary between 20% and 47%, depending on the population study. 1–4 Metabolic syndrome is defined by a complex cluster of risk factors associated with central adipose tissue deposition and insulin resistance. These characteristics, as- sociated with reduced physical activity, are clinical risk factors for cardiovascular disease (CVD). In a recent study, patients with both COPD and metabolic syndrome presented with more frequent exacerbations than COPD without metabolic syndrome. 5 The impact of metabolic syndrome on the COPD mortality rate is unknown. Therefore, the aim of this study was to evaluate the risk of mortality according to the presence of metabolic syndrome in COPD patients who were followed for 5 years. Methods We followed 133 patients with mild to very severe COPD who were attending at the Botucatu Medical School in Brazil, 115 of whom participated in this prospective study. Exclusion criteria included a primary diagnosis of other respiratory diseases or cancer, recent ( < 4 months) myocardial infarction, unstable angina, or congestive heart failure (New York Heart Association class III or IV). To establish a baseline, spi- rometry tests, pulse oximetry, dyspnea scores, anthropometric measurements, and the 6-min walk distance test were used to evaluate all of the patients. Disease severity was categorized according of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages [GOLD I, forced expiratory volume in the first second (FEV 1 ) ‡ 80%; GOLD II, 50 £ FEV 1 < 80%; GOLD III, 30 £ FEV 1 < 50%; GOLD IV, 30% ‡ FEV 1 or < 50% plus chronic respiratory failure]. 6 The body mass index (BMI)/airflow obstruction/dyspnea/exercise ca- pacity (BODE) index was calculated using the model de- scribed by Celli et al. 7 Peripheral blood was collected in the early morning after a 12-hr fast, and the plasma glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs) levels were analyzed. Metabolic syndrome was defined according to Alberti et al. 8 The study was approved by the Research Ethics Committee, and all of the patients provided informed consent. Results Of the 115 patients (21 GOLD stage I, 44 stage II, 16 stage III, and 34 stage IV), 67% had BODE scores of 0–2, and the total mortality was 16.5% (19 patients). The causes of death were pulmonary complications resulting from COPD in 12 patients, CVD in five patients, splenic abscess/ septic shock in one patient, and colon cancer in one patient. We identified 41 (35.6%) patients with metabolic syndrome. Systemic arterial hypertension (47.8%), higher values of waist circumference (WC) (33%), and high levels of serum TGs (33%) were the most frequent findings observed. Patients with metabolic syndrome presented significantly higher BMI values (Table 1). The frequency of metabolic syndrome was similar when COPD patients were compared according to their GOLD or 1 Pulmonology Division and 2 Internal Medicine Division of Botucatu Medical School–UNESP, Botucatu, Sa ˜o Paulo, Brazil. METABOLIC SYNDROME AND RELATED DISORDERS Volume X, Number X, 2014 Ó Mary Ann Liebert, Inc. Pp. 1–3 DOI: 10.1089/met.2014.0100 1