European Heart Journal Advance Access originally published online on February 15, 2007
European Heart Journal 2007 28(7):857-864; doi:10.1093/eurheartj/ehl524
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The metabolic syndrome predicts cardiovascular mortality: a 13-year follow-up study in elderly non-diabetic Finns
1 Department of Medicine, University of Kuopio and Kuopio University Hospital, PO Box 1777, FI-70211 Kuopio, Finland
2 Department of Clinical Nutrition, University of Kuopio and Kuopio University Hospital, PO Box 1777, FI-70211 Kuopio, Finland
Received 18 August 2006; revised 15 January 2007; accepted 18 January 2007; online publish-ahead-of-print 15 February 2007.
* Corresponding author. Tel: +358 17-173949; fax: +358 17-173959. E-mail address: johanna.kuusisto{at}kuh.fi
See page 780 for the editorial comment on this article (doi:10.1093/eurheartj/ehm024)
Aims: The metabolic syndrome (MetS) is defined as a clustering of cardiovascular risk factors characterized by insulin resistance. We investigated the relationship of the MetS and its single components, defined by all six different criteria, with coronary heart disease (CHD), cardiovascular disease (CVD), and all-cause mortality in a prospective population-based study.
Methods and results: The MetS was defined according to the World Health Organization (WHO), the European Group for the Study of Insulin Resistance (EGIR), the National Cholesterol Education Program (NCEP), the American College of Endocrinology (ACE), the International Diabetes Federation (IDF), and the American Heart Association (updated NCEP) criteria. We investgated the relationship of the MetS defined by aforementioned six criteria with CHD, CVD, and all-cause mortality with Cox regression analyses in a non-diabetic Finnish population of 1025 subjects, aged 65–74 years, during the 13-year follow-up. The MetS defined by all aforementioned criteria was associated with a statistically significant risk for CVD mortality when adjusted for all confounding variables (Hazards Ratios, HRs from 1.31 to 1.51). The MetS defined by the WHO, ACE, and IDF criteria was associated with an increased risk of CHD mortality (HRs from 1.42 to 1.58). There was no association between the MetS by any criteria and all-cause mortality. Of the single components of the MetS, the following predicted CVD mortality in multivariable models: impaired fasting glucose by the WHO, NCEP, and ACE criteria (HR 1.34) and by the IDF and updated NCEP criteria (HR 1.29); impaired glucose tolerance by the WHO and ACE criteria (HR 1.55); low HDL cholesterol by the EGIR criteria (HR 1.50) and by the NCEP, IDF, and updated NCEP criteria (HR 1.29); and microalbuminuria according to the WHO definition (HR 1.86).
Conclusion: The MetS defined by all six current criteria predicts CVD mortality in elderly subjects. However, of the single components of the MetS, IFG, IGT, low HDL cholesterol, and microalbuminuria predicted CVD mortality with equal or higher HRs when compared with the different definitions of the MetS. Therefore, our study suggests that the MetS is a marker of CVD risk, but not above and beyond the risk associated with its individual components.
Key Words: Metabolic syndrome • Definition • Cardiovascular disease • Mortality • Predictor
The authors wish it to be known that, in their opinion, the first two authors should be regarded as joint First Authors.
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