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© 2001 by the American Diabetes Association, Inc.
Epidemiology/Health Services/Psychosocial Research |
Cardiovascular Morbidity and Mortality Associated With the Metabolic Syndrome
1 Department of Internal Medicine, Jakobstad Hospital, Jakobstad, Finland
2 Wallenberg laboratory, University of Lund, Malmö, Sweden
3 Department of Medicine, Helsinki University Hospital, Helsinki
4 Närpes Health Center, Närpes
5 Vasa Health Center
6 Department of Medicine, Vasa Central Hospital, Vasa, Finland
7 Department of Endocrinology, Lund University, Malmö, Sweden
OBJECTIVE—To estimate the prevalence of and the cardiovascular risk associated with the metabolic syndrome using the new definition proposed by the World Health Organization (WHO).
RESEARCH DESIGN AND METHODS—A total of 4,483 subjects aged 35–70 years participating in a large family study of type 2 diabetes in Finland and Sweden (the Botnia study) were included in the analysis of cardiovascular risk associated with the metabolic syndrome. In subjects who had type 2 diabetes (n = 1,697), impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) (n = 798), or insulin-resistance with normal glucose tolerance (NGT) (n = 1,988), the metabolic syndrome was defined as presence of at least two of the following risk factors: obesity, hypertension, dyslipidemia, or microalbuminuria. Cardiovascular mortality was assessed in 3,606 subjects with a median follow-up of 6.9 years.
RESULTS—In women and men, respectively, the metabolic syndrome was seen in 10 and 15% of subjects with NGT, 42 and 64% of those with IFG/IGT, and 78 and 84% of those with type 2 diabetes. The risk for coronary heart disease and stroke was increased threefold in subjects with the syndrome (P < 0.001). Cardiovascular mortality was markedly increased in subjects with the metabolic syndrome (12.0 vs. 2.2%, P < 0.001). Of the individual components of the metabolic syndrome, microalbuminuria conferred the strongest risk of cardiovascular death (RR 2.80; P = 0.002).
CONCLUSIONS—The WHO definition of the metabolic syndrome identifies subjects with increased cardiovascular morbidity and mortality and offers a tool for comparison of results from different studies.
Abbreviations: AER, albumin excretion rate • CHD, coronary heart disease • CV, coefficient of variation • ECG, electrocardiogram • GADAb, antibody to GAD • HOMAIR, homeostasis model assessment of insulin resistance • IFG, impaired fasting glucose • IGT, impaired glucose tolerance • MI, myocardial infarction • NGT, normal glucose tolerance • OGTT, oral glucose tolerance test • WHO, World Health Organization • WHR, waist-to-hip ratio
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