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© 2005 by the American Diabetes Association, Inc.
Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes |
The Metabolic Syndrome and 11-Year Risk of Incident Cardiovascular Disease in the Atherosclerosis Risk in Communities Study
1 Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
2 Department of Epidemiology, Merck Research Laboratories, Rahway, New Jersey
3 Department of Medicine, Johns Hopkins University School of Medicine and Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
4 Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
5 Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
6 Methodist DeBakey Heart Center and Department of Medicine, Baylor College of Medicine, Houston, Texas
Address correspondence and reprint requests to Dr. Wayne Rosamond, University of North Carolina, Chapel Hill, 137 E. Franklin St, Chapel Hill, NC 28514. E-mail: wayne_rosamond{at}unc.edu
OBJECTIVE— To assess the magnitude of the association between the National Cholesterol Education Program’s Third Adult Treatment Panel Report (ATP III) definition of the metabolic syndrome and cardiovascular disease (CVD).
RESEARCH DESIGN AND METHODS— Cox regression was used to estimate the relative risk of incident coronary heart disease (CHD) and stroke among 12,089 black and white middle-aged individuals in the Atherosclerosis Risk in Communities (ARIC) study.
RESULTS— The metabolic syndrome was present in 
23% of individuals without diabetes or prevalent CVD at baseline. Over an average of 11 years of follow-up, 879 incident CHD and 216 ischemic stroke events occurred. Among the components of the metabolic syndrome, elevated blood pressure and low levels of HDL cholesterol exhibited the strongest associations with CHD. Men and women with the metabolic syndrome were 1.5 and 2 times more likely to develop CHD than control subjects after adjustment for age, smoking, LDL cholesterol, and race/ARIC center (sex interaction P < 0.03). Similar associations were found between the metabolic syndrome and incident ischemic stroke. Comparison of receiver operating characteristic curves indicated that the metabolic syndrome did not materially improve CHD risk prediction beyond the level achieved by the Framingham Risk Score (FRS).
CONCLUSIONS— Individuals without diabetes or CVD, but with the metabolic syndrome, were at increased risk for long-term cardiovascular outcomes, although statistical models suggested that most of that risk was accounted for by the FRS. Nevertheless, identification of individuals with the metabolic syndrome may provide opportunities to intervene earlier in the development of shared disease pathways that predispose individuals to both CVD and diabetes.
Abbreviations: ARIC, Atherosclerosis Risk in Communities • ATP III, Third Adult Treatment Panel Report • CHD, coronary heart disease • CVD, cardiovascular disease • FRS, Framingham Risk Score • ROC, receiver operating characteristic
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