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European Heart Journal Advance Access originally published online on April 11, 2007
European Heart Journal 2007 28(9):1149-1154; doi:10.1093/eurheartj/ehm063
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Contribution of the metabolic syndrome to sudden death risk in asymptomatic men: the Paris Prospective Study I

Jean-Philippe Empana1,2,*, Pierre Duciemetiere2, Beverley Balkau2 and Xavier Jouven1,2,3

1 INSERM Avenir, Epidemiology of Sudden Death in the Population, Paris XI University
2 INSERM U780, Research in Biostatistics and Epidemiology, Sudden Death and Ischemic Heart Disease Team, Paul Brousse Hospital, Paris XI University, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif, France
3 Department of Cardiology, Georges Pompidou European Hospital, Paris V University, Paris, France

Received 31 May 2006; revised 15 January 2007; accepted 8 March 2007; online publish-ahead-of-print 11 April 2007.

* Corresponding author. Tel: +33 1 45 59 51 00; fax: 33 1 47 26 94 54. E-mail address: empana{at}vjf.inserm.fr

Aims: To compare the risk of sudden death and non-sudden death from myocardial infarction associated with the metabolic syndrome (MetS) in asymptomatic men.

Methods and results: The mortality status of 6678 middle-aged men from the Paris Prospective Study I, who were free of diabetes and coronary heart disease (CHD) at the baseline examination, has been investigated over 21 years of follow-up. The sagittal abdominal diameter was substituted for waist circumference, and HDL cholesterol was unavailable. The presence of three abnormalities and the presence of abdominal adiposity plus at least two abnormalities defined the MetS, using the NCEP-ATP III and IDF criteria, respectively.

Frequency estimate of the MetS was 14.4 and 16.7%, using the NCEP-ATP III and IDF criteria, respectively. The MetS increased the risk of sudden death and non-sudden death by 68% [95% confidence interval (CI) 1.05–2.70] and 38% (95% CI 0.95–2.01), respectively, after adjustment for other CHD risk factors (P for the comparison of the hazard ratios = 0.25). Hazards ratio using the IDF criteria were 2.02 (95% CI 1.30–3.14) and 1.69 (95% CI 1.20–2.38), respectively, (P = 0.26).

Conclusion: In healthy middle-aged men, the MetS increased the risk of sudden death and, to a lesser extent, the risk of non-sudden death over 21 years independent of CHD risk factors.

Key Words: Epidemiology • Sudden cardiac death • Risk factors • Metabolic syndrome


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