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(Circulation. 2009;120:1943-1950.)
© 2009 American Heart Association, Inc.

Epidemiology and Prevention

Trajectories of Entering the Metabolic Syndrome

The Framingham Heart Study

Oscar H. Franco, MD, DSc, PhD; Joseph M. Massaro, PhD; Jacky Civil, PhD; Mark R. Cobain, PhD; Brendan O'Malley, PhD; Ralph B. D'Agostino, Sr, PhD

From Unilever Corporate Research, Sharnbrook, UK (O.H.F., J.C., M.R.C., B.O.); University of Warwick, Warwick Medical School, Health Sciences Research Institute, Coventry, UK (O.H.F.); Department of Mathematics/Statistics and Biostatistics, Boston University, Boston, Mass (J.M.M.); and the National, Heart, Lung and Blood Institute’s Framingham Heart Study, Framingham, Mass (R.B.D.).

Reprint requests to Dr Oscar H. Franco, MD, DSc, PhD, Department of Public Health, B-160, Health Sciences Research Institute, University of Warwick, Coventry, CV4 7AL, UK. E-mail O.H.Franco{at}warwick.ac.uk

Received February 2, 2009; accepted September 4, 2009.

Background— We evaluated the progression of the metabolic syndrome (MetS) and its components, the trajectories followed by individuals entering MetS, and the manner in which different trajectories predict cardiovascular disease and mortality.

Methods and Results— Using data from 3078 participants from the Framingham Offspring Study (a cohort study) who attended examinations 4 (1987), 5 (1991), and 6 (1995), we evaluated the progression of MetS and its components. MetS was defined according to the Adult Treatment Panel III criteria. Using logistic regression, we evaluated the predictive ability of the presence of each component of the MetS on the subsequent development of MetS. Additionally, we examined the probability of developing cardiovascular disease or mortality (until 2007) by having specific combinations of 3 that diagnose MetS. The prevalence of MetS almost doubled in 10 years of follow-up. Hyperglycemia and central obesity experienced the highest increase. High blood pressure was most frequently present when a diagnosis of MetS occurred (77.3%), and the presence of central obesity conferred the highest risk of developing MetS (odds ratio, 4.75; 95% confidence interval, 3.78 to 5.98). Participants who entered the MetS having a combination of central obesity, high blood pressure, and hyperglycemia had a 2.36-fold (hazard ratio, 2.36; 95% confidence interval, 1.54 to 3.61) increase of incident cardiovascular events and a 3-fold (hazard ratio, 3.09, 95% confidence interval, 1.93 to 4.94) increased risk of mortality.

Conclusions— Particular trajectories and combinations of factors on entering the MetS confer higher risks of incident cardiovascular disease and mortality in the general population and among those with MetS. Intense efforts are required to identify populations with these particular combinations and to provide them with adequate treatment at early stages of disease.

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Circulation 2009 120: 1935-1936. [Extract] [Full Text]