on August 23, 2004
Circulation. 2004
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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Submitted on February 8, 2004
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.). * To whom correspondence should be addressed. E-mail: ndwong{at}uci.edu.
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.
Revised on May 24, 2004
Accepted on May 27, 2004
Impact of the Metabolic Syndrome on Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in United States Adults
Shaista Malik MD, MPH,
Key words: diabetes mellitus • risk factors • metabolic syndrome X • mortality
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Circulation 2004 110: 1177.
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