Circulation. 2004;110:1251-1257
Published online before print August 23, 2004, doi: 10.1161/01.CIR.0000140762.04598.F9
Published online before print August 23, 2004, doi: 10.1161/01.CIR.0000140762.04598.F9
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(Circulation. 2004;110:1251-1257.)
© 2004 American Heart Association, Inc.
Original Articles |
National Cholesterol Education Program Versus World Health Organization Metabolic Syndrome in Relation to All-Cause and Cardiovascular Mortality in the San Antonio Heart Study
From the Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex.
Correspondence to Kelly J. Hunt, PhD, Division of Clinical Epidemiology/Medicine, UTHSCSA, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900. E-mail huntk{at}uthscsa.edu
Received December 17, 2003; de novo received March 16, 2004; revision received April 22, 2004; accepted April 26, 2004.
Background— To assess the utility of clinical definitions of the metabolic syndrome (MetS) to identify individuals with increased cardiovascular risk, we examined the relation between the MetS, using both the National Cholesterol Education Program (NCEP) and the World Health Organization definitions, and all-cause and cardiovascular mortality in San Antonio Heart Study participants enrolled between 1984 and 1988.
Methods and Results— Among 2815 participants, 25 to 64 years of age at enrollment, 509 met both criteria, 197 met NCEP criteria only, and 199 met WHO criteria only. Over an average of 12.7 years, 229 deaths occurred (117 from cardiovascular disease). Moreover, in the primary prevention population of 2372 participants (ie, those without diabetes or cardiovascular disease at baseline), 132 deaths occurred (50 from cardiovascular disease). In the primary prevention population, the only significant association adjusted for age, gender, and ethnic group was between NCEP-MetS and cardiovascular mortality (hazard ratio [HR], 2.01; 95% CI, 1.13–3.57). In the general population, all-cause mortality HRs were 1.47 (95% CI, 1.13–1.92) for NCEP-MetS and 1.27 (95% CI, 0.97–1.66) for WHO-MetS. Furthermore, for cardiovascular mortality, there was evidence that gender modified the predictive ability of the MetS. For women and men, respectively, HRs for NCEP-MetS were 4.65 (95% CI, 2.35–9.21) and 1.82 (95% CI, 1.14–2.91), whereas HRs for WHO-MetS were 2.83 (95% CI, 1.55–5.17) and 1.15 (95% CI, 0.72–1.86).
Conclusions— In summary, although both definitions were predictive in the general population, the simpler NCEP definition tended to be more predictive in lower-risk subjects.
Key Words: diabetes mellitus • cardiovascular diseases • epidemiology • mortality • risk factors
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