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(Circulation. 2003;108:414.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Metabolic Syndrome With and Without C-Reactive Protein as a Predictor of Coronary Heart Disease and Diabetes in the West of Scotland Coronary Prevention Study

Naveed Sattar, MD; Allan Gaw, MD; Olga Scherbakova, MSc; Ian Ford, PhD; Denis St.J. O’Reilly, MD; Steven M. Haffner, MD; Chris Isles, MD; Peter W. Macfarlane, DSc; Chris J. Packard, DSc; Stuart M. Cobbe, MD; James Shepherd, MD

From the University Departments of Pathological Biochemistry (N.S., D.J.O.R., C.J.P., J.S.), Clinical Trials Unit (A.G.), Division of Cardiovascular and Medical Sciences (P.W.M., S.M.C.), Glasgow Royal Infirmary, Glasgow, UK; Robertson Centre for Biostatistics (O.S., I.F.), University of Glasgow, Glasgow, UK; Department of Medicine (S.M.H.), University of Texas Health Science Center at San Antonio; and Department of Medicine (C.I.), Dumfries and Galloway District General Hospital, Dumfries, Scotland.

Correspondence to Dr Naveed Sattar, University Department of Pathological Biochemistry, Glasgow Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, Scotland, UK. E-mail nsattar{at}clinmed.gla.ac.uk

Received February 24, 2003; revision received May 6, 2003; accepted May 7, 2003.

Background— The National Cholesterol Education Program (NCEP) recently proposed a simple definition for metabolic syndrome. Information on the prospective association of this definition for coronary heart disease (CHD) and type 2 diabetes is currently limited.

Methods and Results— We used a modified NCEP definition with body mass index in place of waist circumference. Baseline assessments in the West of Scotland Coronary Prevention Study were available for 6447 men to predict CHD risk and for 5974 men to predict incident diabetes over 4.9 years of follow-up. Mean LDL cholesterol was similar but C-reactive protein was higher (P<0.0001) in the 26% of men with the syndrome compared with those without. Metabolic syndrome increased the risk for a CHD event [univariate hazard ratio (HR)=1.76 (95% CI, 1.44 to 2.15)] and for diabetes [univariate HR=3.50 (95% CI 2.51 to 4.90)]. Metabolic syndrome continued to predict CHD events (HR=1.30, 95% CI, 1.00 to 1.67, P=0.045) in a multivariate model incorporating conventional risk factors. Men with 4 or 5 features of the syndrome had a 3.7-fold increase in risk for CHD and a 24.5-fold increase for diabetes compared with men with none (both P<0.0001). C-reactive protein enhanced prognostic information for both outcomes. With pravastatin, men with the syndrome had similar risk reduction for CHD as compared with those without (HR, 0.73 and 0.69; pravastatin versus placebo).

Conclusions— A modified NCEP metabolic syndrome definition predicts CHD events, and, more strikingly, new-onset diabetes, and thus helps identify individuals who may receive particular benefit from lifestyle measures to prevent these diseases.

Key Words: insulin • coronary disease • obesity • inflammation • glucose

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				A. J.G. Hanley, A. J. Karter, K. Williams, A. Festa, R. B. D'Agostino Jr, L. E. Wagenknecht, and S. M. Haffner Prediction of Type 2 Diabetes Mellitus With Alternative Definitions of the Metabolic Syndrome: The Insulin Resistance Atherosclerosis Study Circulation, December 13, 2005; 112(24): 3713 - 3721. [Abstract] [Full Text] [PDF]

				S. G. Wannamethee, A. G. Shaper, L. Lennon, and R. W. Morris Metabolic Syndrome vs Framingham Risk Score for Prediction of Coronary Heart Disease, Stroke, and Type 2 Diabetes Mellitus Arch Intern Med, December 12, 2005; 165(22): 2644 - 2650. [Abstract] [Full Text] [PDF]

				P. W.F. Wilson, R. B. D'Agostino, H. Parise, L. Sullivan, and J. B. Meigs Metabolic Syndrome as a Precursor of Cardiovascular Disease and Type 2 Diabetes Mellitus Circulation, November 15, 2005; 112(20): 3066 - 3072. [Abstract] [Full Text] [PDF]

				N. D Wong Review: Cardiovascular risk assessment in the metabolic syndrome, screening for subclinical disease, and implications for treatment The British Journal of Diabetes & Vascular Disease, November 1, 2005; 5(6): 305 - 313. [Abstract] [PDF]

				A. J.G. Hanley, K. Williams, A. Festa, L. E. Wagenknecht, R. B. D'Agostino Jr, and S. M. Haffner Liver Markers and Development of the Metabolic Syndrome: The Insulin Resistance Atherosclerosis Study Diabetes, November 1, 2005; 54(11): 3140 - 3147. [Abstract] [Full Text] [PDF]

				M. K. Rutter, J. B. Meigs, L. M. Sullivan, R. B. D'Agostino Sr, and P. W. Wilson Insulin Resistance, the Metabolic Syndrome, and Incident Cardiovascular Events in the Framingham Offspring Study Diabetes, November 1, 2005; 54(11): 3252 - 3257. [Abstract] [Full Text] [PDF]

				L. Citrome Metabolic Syndrome and Cardiovascular Disease J Psychopharmacol, November 1, 2005; 19(6_suppl): 84 - 93. [Abstract] [PDF]