Circulation. 2004;110:1245-1250
Published online before print August 23, 2004, doi: 10.1161/01.CIR.0000140677.20606.0E
Published online before print August 23, 2004, doi: 10.1161/01.CIR.0000140677.20606.0E
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(Circulation. 2004;110:1245-1250.)
© 2004 American Heart Association, Inc.
Original Articles |
Impact of the Metabolic Syndrome on Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in United States Adults
From the Heart Disease Prevention Program, University of California, Irvine (S.M., N.D.W., S.S.F., J.R.P.), and Bristol-Myers Squibb Pharmaceutical Research Institute, Princeton, NJ (T.V.K., G.J.L., G.R.W.).
Reprint requests to Nathan D. Wong, PhD, MPH, Heart Disease Prevention Program, Department of Medicine, C240 Medical Sciences, University of California, Irvine, CA 92697. E-mail ndwong{at}uci.edu
Received February 8, 2004; de novo received April 2, 2004; revision received May 24, 2004; accepted May 27, 2004.
Background— Mortality resulting from coronary heart disease (CHD), cardiovascular disease (CVD), and all causes in persons with diabetes and pre-existing CVD is high; however, these risks compared with those with metabolic syndrome (MetS) are unclear. We examined the impact of MetS on CHD, CVD, and overall mortality among US adults.
Methods and Results— In a prospective cohort study, 6255 subjects 30 to 75 years of age (54% female) (representative of 64 million adults in the United States) from the Second National Health and Nutrition Examination Survey were followed for a mean±SD of 13.3±3.8 years. MetS was defined by modified National Cholesterol Education Program criteria. From sample-weighted multivariable Cox proportional-hazards regression, compared with those with neither MetS nor prior CVD, age-, gender-, and risk factor–adjusted hazard ratios (HRs) for CHD mortality were 2.02 (95% CI, 1.42 to 2.89) for those with MetS and 4.19 (95% CI, 3.04 to 5.79) for those with pre-existing CVD. For CVD mortality, HRs were 1.82 (95% CI, 1.40 to 2.37) and 3.14 (95% CI, 2.49 to 3.96), respectively; for overall mortality, HRs were 1.40 (95% CI, 1.19 to 1.66) and 1.87 (95% CI, 1.60 to 2.17), respectively. In persons with MetS but without diabetes, risks of CHD and CVD mortality remained elevated. Diabetes predicted all mortality end points. Those with even 1 to 2 MetS risk factors were at increased risk for mortality from CHD and CVD. Moreover, MetS more strongly predicts CHD, CVD, and total mortality than its individual components.
Conclusions— CHD, CVD, and total mortality are significantly higher in US adults with than in those without MetS.
Key Words: diabetes mellitus • risk factors • metabolic syndrome X • mortality
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Circulation 2004 110: 1177.
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S. Maggi, M. Noale, P. Gallina, D. Bianchi, C. Marzari, F. Limongi, G. Crepaldi, and for the ILSA Working Group Metabolic syndrome, diabetes, and cardiovascular disease in an elderly caucasian cohort: the italian longitudinal study on aging. J. Gerontol. A Biol. Sci. Med. Sci., May 1, 2006; 61(5): 505 - 510. [Abstract] [Full Text] [PDF]
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P. Poirier, T. D. Giles, G. A. Bray, Y. Hong, J. S. Stern, F. X. Pi-Sunyer, and R. H. Eckel Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Arterioscler Thromb Vasc Biol, May 1, 2006; 26(5): 968 - 976. [Abstract] [Full Text] [PDF]
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J. S. Rana, A. C. Jansen, A. H. Zwinderman, M. Nieuwdorp, E. S. van Aalst-Cohen, J. W. Jukema, M. D. Trip, and J. J.P. Kastelein Metabolic Syndrome and Risk of Coronary, Cerebral, and Peripheral Vascular Disease in a Large Dutch Population With Familial Hypercholesterolemia Diabetes Care, May 1, 2006; 29(5): 1125 - 1127. [Full Text] [PDF]
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G. Schillaci, M. Pirro, G. Pucci, M. R. Mannarino, F. Gemelli, D. Siepi, G. Vaudo, and E. Mannarino Different Impact of the Metabolic Syndrome on Left Ventricular Structure and Function in Hypertensive Men and Women Hypertension, May 1, 2006; 47(5): 881 - 886. [Abstract] [Full Text] [PDF]
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J. Butler, N. Rodondi, Y. Zhu, K. Figaro, S. Fazio, D. E. Vaughan, S. Satterfield, A. B. Newman, B. Goodpaster, D. C. Bauer, et al. Metabolic Syndrome and the Risk of Cardiovascular Disease in Older Adults J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1595 - 1602. [Abstract] [Full Text] [PDF]
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K. Matsushita, H. Yatsuya, K. Tamakoshi, K. Wada, R. Otsuka, S. Takefuji, K. Sugiura, T. Kondo, T. Murohara, and H. Toyoshima Comparison of Circulating Adiponectin and Proinflammatory Markers Regarding Their Association With Metabolic Syndrome in Japanese Men Arterioscler Thromb Vasc Biol, April 1, 2006; 26(4): 871 - 876. [Abstract] [Full Text] [PDF]
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H.-J. Chen, C.-H. Bai, W.-T. Yeh, H.-C. Chiu, and W.-H. Pan Influence of Metabolic Syndrome and General Obesity on the Risk of Ischemic Stroke Stroke, April 1, 2006; 37(4): 1060 - 1064. [Abstract] [Full Text] [PDF]
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S. M. Grundy Metabolic Syndrome: Connecting and Reconciling Cardiovascular and Diabetes Worlds J. Am. Coll. Cardiol., March 21, 2006; 47(6): 1093 - 1100. [Abstract] [Full Text] [PDF]
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J. Dallongeville, M.-C. Grupposo, D. Cottel, J. Ferrieres, D. Arveiler, A. Bingham, J.-B. Ruidavets, B. Haas, P. Ducimetiere, and P. Amouyel Association between the metabolic syndrome and parental history of premature cardiovascular disease Eur. Heart J., March 2, 2006; 27(6): 722 - 728. [Abstract] [Full Text] [PDF]
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P. Kohli and P. Greenland Role of the Metabolic Syndrome in Risk Assessment for Coronary Heart Disease JAMA, February 15, 2006; 295(7): 819 - 821. [Full Text] [PDF]
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P. Poirier, T. D. Giles, G. A. Bray, Y. Hong, J. S. Stern, F. X. Pi-Sunyer, and R. H. Eckel Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss: An Update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease From the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism Circulation, February 14, 2006; 113(6): 898 - 918. [Abstract] [Full Text] [PDF]
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T. Thom, N. Haase, W. Rosamond, V. J. Howard, J. Rumsfeld, T. Manolio, Z.-J. Zheng, K. Flegal, C. O'Donnell, S. Kittner, et al. Heart Disease and Stroke Statistics--2006 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, February 14, 2006; 113(6): e85 - e151. [Full Text] [PDF]
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P. T. Katzmarzyk, I. Janssen, R. Ross, T. S. Church, and S. N. Blair The Importance of Waist Circumference in the Definition of Metabolic Syndrome: Prospective analyses of mortality in men Diabetes Care, February 1, 2006; 29(2): 404 - 409. [Abstract] [Full Text] [PDF]
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L. Lind, B. Vessby, and J. Sundstrom The Apolipoprotein B/AI Ratio and the Metabolic Syndrome Independently Predict Risk for Myocardial Infarction in Middle-Aged Men Arterioscler Thromb Vasc Biol, February 1, 2006; 26(2): 406 - 410. [Abstract] [Full Text] [PDF]
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M. Pladevall, B. Singal, L. K. Williams, C. Brotons, H. Guyer, J. Sadurni, C. Falces, M. Serrano-Rios, R. Gabriel, J. E. Shaw, et al. A Single Factor Underlies the Metabolic Syndrome: A confirmatory factor analysis Diabetes Care, January 1, 2006; 29(1): 113 - 122. [Abstract] [Full Text] [PDF]
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L. E. Eberly, R. Prineas, J. D. Cohen, G. Vazquez, X. Zhi, J. D. Neaton, L. H. Kuller, and for the Multiple Risk Factor Intervention Trial Re Metabolic Syndrome: Risk factor distribution and 18-year mortality in the Multiple Risk Factor Intervention Trial Diabetes Care, January 1, 2006; 29(1): 123 - 130. [Abstract] [Full Text] [PDF]
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C. Lahoz, I. Vicente, F. Laguna, M. F. Garcia-Iglesias, M. Taboada, and J. M. Mostaza Metabolic Syndrome and Asymptomatic Peripheral Artery Disease in Subjects Over 60 Years of Age Diabetes Care, January 1, 2006; 29(1): 148 - 150. [Full Text] [PDF]
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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]
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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]
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