Relation of the Number of Metabolic Syndrome Risk Factors With All-Cause and Cardiovascular Mortality

      The metabolic syndrome (MS) is a constellation of risk factors associated with diabetes and cardiovascular disease. This syndrome consists of at least 3 parameters assessing central obesity, hypertension, high-density lipoprotein cholesterol, triglycerides, and impaired glucose metabolism. Whether persons with 4 or 5 risk factors are at higher risk than those with 3 risk factors is unclear. Also unclear is whether those without the MS but with 1 or 2 risk factors warrant therapy. We assessed cardiovascular and all-cause mortality as a function of the number of these risk factors. We followed 30,365 men for a median follow-up of 13.6 years. During follow-up, 1,449 participants died, 527 from cardiovascular causes. All of the individual parameters defining the MS were significantly associated with both all-cause and cardiovascular mortality (p <0.001). After adjustment for age and the other MS variables, hypertension was the most potent risk factor whereas central obesity and hypertriglyceridemia remained associated with both all-cause and cardiovascular mortality. A highly significant trend was also noted between both all-cause or cardiovascular mortality and the number of risk factors (p <0.001 for trend). Risk increased incrementally, beginning at 1 risk factor for cardiovascular mortality and at 2 risk factors for all-cause mortality. In conclusion, there is a continuum of risk as the number of metabolic syndrome risk factors increases. These findings add to the growing evidence that central obesity can independently and adversely affect health.
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        • Grundy S.
        • Cleeman J.
        • Daniels S.
        • Donato K.
        • Eckel R.
        • Franklin B.
        • Gordon D.
        • Krauss R.
        • Savage P.
        • Smith S.
        • Spertus J.
        • Costa F.
        Diagnosis and management of the metabolic syndrome.
        Circulation. 2005; 112: 2735-2752
      1. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).
        JAMA. 2001; 285: 2486-2497
        • Wilson P.
        • Kannel W.
        • Silbershatz H.
        • D'Agostino R.
        Clustering of metabolic factors and coronary heart disease.
        Arch Intern Med. 1999; 159: 1104-1109
        • Isomaa B.
        • Almgren P.
        • Tuomi T.
        • Forsen B.
        • Lahti K.
        • Nissen M.
        • Taskinen M.
        • Groop L.
        Cardiovascular morbidity and mortality associated with the metabolic syndrome.
        Diabetes Care. 2001; 24: 683-689
        • Hunt K.
        • Resendez R.
        • Williams K.
        • Haffner S.
        • Stern M.
        National Cholesterol Education Program versus World Health Organization metabolic syndrome in relation to all-cause and cardiovascular mortality in the San Antonio Heart Study.
        Circulation. 2004; 110: 1251-1257
        • Katzmarzyk P.
        • Church T.
        • Blair S.
        Cardiorespiratory fitness attenuates the effects of the metabolic syndrome on all-cause and cardiovascular disease mortality in men.
        Arch Intern Med. 2004; 164: 1092-1097
        • Lakka H.
        • Laaksonen D.
        • Lakka T.
        • Niskanen L.
        • Kumpusalo E.
        • Tuomilehto J.
        • Salonen J.
        The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men.
        JAMA. 2002; 288: 2709-2716
        • Malik S.
        • Wong N.
        • Franklin S.
        • Kamath T.
        • L'Italien G.
        • Pio J.
        • Williams G.
        Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults.
        Circulation. 2004; 110: 1245-1250
        • Hu G.
        • Qiao Q.
        • Tuomilehto J.
        • Balkau B.
        • Borch-Johnsen K.
        • Pyorala K.
        • DECODE Study Group
        Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in non-diabetic European men and women.
        Arch Intern Med. 2004; 164: 1066-1076
        • Ford E.
        The metabolic syndrome and mortality from cardiovascular disease and all-causes: findings from the National Health and Nutrition Examination Survey II mortality study.
        Atherosclerosis. 2004; 173: 309-314
        • Kadota A.
        • Hozawa A.
        • Okamura T.
        • Kadowak T.
        • Nakmaura K.
        • Murakami Y.
        • Hayakawa T.
        • Kita Y.
        • Okayama A.
        • Nakamura Y.
        • et al.
        • NIPPON DATA Research Group
        Relationship between metabolic risk factor clustering and cardiovascular mortality stratified by high blood glucose and obesity.
        Diabetes Care. 2007; 30: 1533-1538
        • Schillaci G.
        • Pirro M.
        • Vaudo G.
        • Gemilli F.
        • Marchesi S.
        • Porcellati C.
        • Mannarino E.
        Prognostic value of the metabolic syndrome in essential hypertension.
        J Am Coll Cardiol. 2004; 43: 1817-1822