Metabolic syndrome and the risk of new vascular events and all-cause mortality in patients with coronary artery disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm
1 Department of Vascular Medicine, University Medical Centre Utrecht, Heidelbergiaan 100, Po Box 85500, 3508 GA Utrecht, The Netherlands
2 Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
Received 28 March 2007; revised 10 October 2007; accepted 22 November 2007.
* Corresponding author. Tel: +31 88 75 555 55, Fax: +31 30 250 5488. Email: f.l.j.visseren{at}umcutrecht.nl
Aims: To investigate the vascular risk associated with Metabolic Syndrome (MetS) according to different clinical criteria with subsequent vascular events and all-cause mortality in patients with coronary artery disease, cerebrovascular disease, peripheral artery disease or abdominal aortic aneurysm and to examine whether patients with MetS at treatment goals for systolic blood pressure (SBP) or low density lipoprotein-cholesterol (LDL-c) level are still at elevated risk.
Methods and results: Prospective study of 3196 patients with a history or recent diagnosis of clinically manifest vascular disease. During a median follow-up of 3.2 years (interquartile range 1.4–5.4 years), 331 patients died and 373 patients experienced a first vascular event. National Cholesterol Education Program (NCEP) and revised NCEP (NCEP-R)-defined MetS were related to increased risk of vascular events [HR – hazard ratio 1.50 (95% CI – confidence interval 1.22–1.84) and 1.50 (1.22–1.87)] and all-cause mortality [HR 1.49(1.20–1.84) and 1.43 (1.14–1.78)]. Results were similar in the 2472 patients without type 2 diabetes (DM2) and localization of vascular disease; SBP-category (<140 or 
140 mmHg) or LDL-category (<2.5 or 2.5 mmol/L) did not affect this relation.
Conclusion: In patients with various manifestations of atherosclerosis, presence of NCEP and NCEP-R-defined MetS is associated with increased risk of cardiovascular events and all-cause mortality, independently of the presence of DM2. This risk is significantly higher than the risk associated with International Diabetes Federation-defined MetS. Also in patients at treatment goals for SBP (<140 mmHg) or LDL-c (<2.5 mmol/L) according to current guidelines, presence of NCEP-R-defined MetS points to a higher vascular risk.
Key Words: Metabolic syndrome • Cardiovascular risk • Localization of atherosclerosis • Systolic blood pressure • LDL-cholesterol • Treatment goals