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. |