Abstract 4105: Does the Metabolic Syndrome Predict Mortality in Older Adults? The Cardiovascular Health Study
Background Utility of metabolic syndrome (MetS) for predicting mortality among older adults, the highest risk population, is not established. Some MetS criteria, their dichotomization, or the chosen cutpoints may not be optimal in this population. We evaluated whether MetS predicted total mortality among older persons and compared the predictive ability of different individual criteria and cutpoints.
Methods We prospectively evaluated the association of MetS by ATP III criteria with mortality among 4,244 men and women ≥ age 65 and free of known CVD at baseline. Risk was estimated using Cox PH, age- and gender-adjusted (testing prediction) and also adjusted for other risk factors.
Results At baseline (mean age 73), 30% of men and 37% of women had MetS (≥3 of 5 criteria). During 12 yrs of follow-up, 1,680 deaths occurred. Compared to persons not having MetS, those with MetS had 30% higher mortality (RR=1.30; 95% CI 1.18–1.44). However, higher risk with MetS was confined to persons having elevated fasting glucose/diabetes (EFG) as one of the criteria (RR=1.49; 1.33–1.67); persons with MetS but no EFG did not have higher risk (1.04; 0.89–1.21). Among individual MetS criteria, only HTN and EFG predicted higher mortality; persons having both HTN and EFG had highest mortality (Table⇓). Results were similar when different criterion cutpoints (e.g., quantiles) were evaluated or when analyses excluded smokers, persons with cancer or chronic lung disease, and deaths during the first year. Further adjustment for race, education, smoking, physical activity, and alcohol use had little effect. Risk associated with MetS was slightly higher in men vs. women (p interaction=0.03), but results were otherwise qualitatively similar in men vs. women. Interaction by age or CRP levels was not evident.
Conclusions These findings suggest limited utility of the MetS concept for predicting mortality in older men or women, compared with assessment of fasting glucose and blood pressure alone.