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Metabolic Syndrome and Incident End-Stage Peripheral Vascular Disease

A 14-year follow-up study in elderly Finns

From the Department of Medicine, Kuopio University Hospital, Kuopio, Finland

Address correspondence and reprint requests to Johanna Kuusisto, MD, Medicine, Cardiology Unit, Kuopio University Hospital, P.O. Box 1777, 70211 Kuopio, Finland. E-mail: johanna.kuusisto{at}kuh.fi

OBJECTIVE—We investigated the relationship of the metabolic syndrome and its single components, defined by four different criteria, with peripheral vascular disease (PVD) in a prospective population-based study.

RESEARCH DESIGN AND METHODS—The metabolic syndrome was defined according to the World Health Organization (WHO), the National Cholesterol Education Program (NCEP), the International Diabetes Federation (IDF), and the American Heart Association (updated NCEP) criteria. We investigated the relationship of the metabolic syndrome defined by the aforementioned four criteria with PVD (revacularization and amputation) by Cox regression analyses in a Finnish population of 1,212 subjects, aged 65–74 years, with and without diabetes during a 14-year follow-up.

RESULTS—The metabolic syndrome defined by the WHO, NCEP, and updated NCEP criteria was associated with a statistically significant risk for incident PVD (n = 57) with adjustment for all confounding variables except for prevalent diabetes (hazard ratios [HRs] from 1.91 to 2.62). After adjustment for prevalent diabetes or after the exclusion of subjects with prevalent diabetes, there was no association between the metabolic syndrome by any criteria and incident PVD. Of the single components of the metabolic syndrome, elevated fasting glucose by the WHO and NCEP criteria (HR 2.35) and microalbuminuria by the WHO definition (2.56) predicted PVD in multivariable models (prevalent diabetes included).

CONCLUSIONS—The metabolic syndrome defined by the WHO, NCEP, and updated NCEP criteria predicted incident end-stage PVD in elderly Finns but only when not adjusted for diabetes status. Two of the single components of the metabolic syndrome, elevated fasting plasma glucose and microalbuminuria, predicted PVD. We conclude that the metabolic syndrome predicts PVD but not above and beyond the risk associated with diabetes and microalbuminuria.

Abbreviations: ACR, ratio of urinary albumin to urinary creatinine • CHD, coronary heart disease • CVD, cardiovascular disease • FPG, fasting plasma glucose • IDF, International Diabetes Federation • IGT, impaired glucose tolerance • NCEP, National Cholesterol Education Program • PVD, peripheral vascular disease • WHO, World Health Organization

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