Metabolic syndrome, diabetes, HEAT assessment tool, and lifestyle interventions were among the many study findings reported at the National Lipid Association (NLA) Scientific Sessions, held in Atlanta, Georgia, between June 1 and June 4, 2023.

Is Metabolic Syndrome Associated With Increased Risk of Mortality After PCI?

Patients with metabolic syndrome are not at significantly higher risk of in-hospital mortality after undergoing percutaneous coronary intervention (PCI) compared with the general population.

Metabolic syndrome is associated with an increased risk of cardiovascular disease symptoms because of its impact on multiple organ systems. One well-known effect of metabolic syndrome is coronary artery disease.

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To study the prognostic effects of metabolic syndrome on the outcome of PCI, researchers enrolled 32,764 patients in a retrospective study, of which 0.04% of patients had a history of metabolic syndrome. Study outcomes included the incidence of thrombosis, acute kidney injury, cardiogenic shock, cardiovascular accident, operative complications, ventricular tachycardia, ventricular fibrillation, and death.

Researchers found that compared with the general population, patients with a history of metabolic syndrome did not experience higher rates of mortality (P =.7726), coronary artery thrombosis (P =.1309), acute kidney injury (P =.4399), cardiogenic shock (P =.3925), cardiovascular accident (P =.1443), intraoperative and postoperative complications (P =.1498), ventricular tachycardia (P =.7298), or ventricular fibrillation (P =.4869) after PCI.

Overall, no significant differences were found in mortality rates and other disease states between patients with metabolic syndrome and the general population who underwent PCI, concluded the authors.


Amoah JK, Noureldin S, Fatuyi M, Dekowski S, Cano FS. The outcome of percutaneous coronary intervention in patients with metabolic syndrome. A nationwide analysis. Abstract presented at: National Lipid Association (NLA) Scientific Sessions 2023; June 1-4, 2023; Atlanta, GA. Abstract #193.

Novel Risk Prediction Model Identifies Patients at Increased Risk for Diabetes

Novel biochemical risk prediction models were found to accurately identify patients with prediabetes and diabetes who may benefit from lifestyle modifications.

Diabetes mellitus is a major cause of cardiovascular disease (CVD), kidney disease, neuropathy, and loss of vision. Researchers studied data from 2414 diabetes-free patients included in the longitudinal Framingham Offspring Study. The model factored in such variables as the use of cholesterol-lowering medication, parental history of diabetes, BMI, and blood levels such as total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, glucose, glycated serum albumin, insulin, and adiponectin. The researchers studied the development of new cases of diabetes over a mean follow-up period of 10 years.

The risk prediction model was applied to a large fasting population (N=133,764). The model found that 36.2% of patients were considered prediabetic (10-year diabetes risk, 5.5%), 7.5% were considered diabetic (10-year diabetes risk, 100%), and 56.3% were neither prediabetic nor diabetic (10-year diabetes risk, 0.3%). Homeostasis model assessment was calculated for insulin resistance and production to identify patients who require insulin therapy.

For patients with diabetes, 10.7% received lifestyle modification; which led to a greater number of patients no longer having diabetes compared with those who did not use a lifestyle modification plan (8.2% vs 3.4%; P <.001). For patients with prediabetes, 12% opted for the lifestyle plan. The change in diabetes risk decreased from 5.7% to 3.1% among patients with prediabetes who received lifestyle modification compared with no change in diabetes risk among those who did not (P <.001). The homeostasis model assessment calculations indicated that approximately 25% of diabetic subjects had decreased insulin production. 

Overall, the risk prediction model was successful in identifying patients with prediabetes or diabetes who would benefit from the initiation of successful lifestyle modifications. Additional lifestyle changes significantly lowered the risk of diabetes in patients with prediabetes, the authors concluded.


Schaefer EJ, Ai M, Gleason J, Liu C, Dansinger ML. The prediction and prevention of diabetes. Abstract presented at: National Lipid Association (NLA) Scientific Sessions 2023; June 1-4, 2023; Atlanta, GA. Abstract 187.

HEAT Dietary Assessment Tool Useful for Children With Dyslipidemia

Traditional dietary assessments require intensive resources and time to determine whether children and adolescents with dyslipidemia have achieved cholesterol-lowering dietary targets outlined in the Cardiovascular Health Integrated Lifestyle Diet (CHILD-2).

To simplify this task, researchers developed a 10-point assessment tool, known as Healthy Eating Assessment Tool (HEAT). To study whether the tool meets the dietary fat and cholesterol restriction guidelines of CHILD-2, the research team conducted a 2-year single-center, prospective cross-sectional study. The study enrolled patients aged 2 to 18 years from a pediatric dyslipidemia clinic.

The researchers investigated the relationship between individual HEAT scores and HEAT score categories (poor, 0-4.5; fair, 5-6.5; good, 7-8.5; and excellent, 9-10) and nutritional analysis findings from 7-day food records, body mass index (BMI) z-score, waist-to-height ratio, and lipid variables.

The study result showed that only patients with the highest HEAT scores (good, 43%; excellent, 64%) met the CHILD-2 cut point of less than 25% of total calories from fat calories (P =.03). There was a non-significant trend of reducing saturated fat to less than 8% total daily calories among excellent HEAT scores (excellent, 64%; P =.08) and there was no association with cholesterol intake. Lower HEAT scores were associated with an increased BMI z-score (r = -0.31, P <.01) and waist-to-height ratio (r = -0.31, P <.01).

Although fat-restricted diets are safe, they have limited efficacy in treating dyslipidemia or managing weight alone. The HEAT assessment tool offers a simplified and valuable approach for evaluating and monitoring broader dietary goals in clinical settings.


Wong JP, DiLauro S, Collins T, Chahal N, McCrindle BW. The Healthy Eating Assessment Tool (HEAT): a simplified 10-point assessment of CHILD-2 dietary compliance for children and adolescents with dyslipidemia. Abstract presented at: National Lipid Association (NLA) Scientific Sessions 2023; June 1-4, 2023; Atlanta, GA. Abstract 159

Lifestyle Interventions Associated With Changes in Waist Circumference, Weight, BMI in MetS

Early implementation of lifestyle modification has been shown to decrease rates of obesity, improve metabolic function, and reduce mortality in patients with metabolic syndrome. In a quality improvement project, researchers aimed to improve the identification, education, and adherence in adult patients with metabolic syndrome.

The project was conducted at a primary care nurse practitioner clinic in Southeast Texas. The researchers focused on consistent diagnosis and education; weight, waist circumference documentation, and body mass index; dietary behavior, physical activity, and health literacy. The study also included an evaluation of staff knowledge, perceived education efficacy, and provider satisfaction.

The program involved chart review, written and verbal education, accurate diagnosis of MetS (glucose >100 mg/dL; blood pressure >130/85 mm Hg; high-density lipoprotein cholesterol <40 mg/dL[men] or <50 mg/dL [women]; waist circumference >40 in [men] or >35 in [women]; and triglycerides >150 mg/dL), and frequency of waist circumference documentation. The researcher evaluated physical activity and dietary habits through surveys and assessed provider and staff measurement processes, self-perceived efficacy, satisfaction, and health literacy.

At baseline screening, 7 out of 25 participants met 3 or more diagnostic criteria for metabolic syndrome. After the project’s completion, this number increased to 23 out of 25 participants.

Clinicians should emphasize early diagnosis and lifestyle changes, incorporating both verbal and written education to enhance health literacy.


Shackelford S. Lifestyle intervention in primary care patients with metabolic syndrome. Abstract presented at: National Lipid Association (NLA) Scientific Sessions 2023; June 1-4, 2023; Atlanta, GA. Poster 109.