Metabolic Syndrome as a Risk Factor for Cardiovascular Disease, Mortality, and Progression of Diabetic Nephropathy in Type 1 Diabetes

doi:10.2337/dc08-2022

Metabolic Syndrome as a Risk Factor for Cardiovascular Disease, Mortality, and Progression of Diabetic Nephropathy in Type 1 Diabetes

Lena M. Thorn, MD¹,²,
Carol Forsblom, DMSC¹,²,
Johan Wadén, MD¹,²,
Markku Saraheimo, MD¹,²,
Nina Tolonen, MD¹,²,
Kustaa Hietala, MD¹,
Per-Henrik Groop, DMSC¹,² and
for the Finnish Diabetic Nephropathy (FinnDiane) Study Group*

¹Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland;
²Department of Medicine, Division of Nephrology, Helsinki University Hospital, Helsinki, Finland.

Corresponding author: Per-Henrik Groop, per-henrik.groop{at}helsinki.fi

Abstract

OBJECTIVE To assess the predictive value of the metabolic syndrome in patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS Patients were from the prospective Finnish Diabetic Nephropathy (FinnDiane) Study (n = 3,783): mean age 37 ± 12 years and diabetes duration 23 ± 12 years. Metabolic syndrome was defined according to World Health Organization (WHO), National Cholesterol Education Program (NCEP), and International Diabetes Federation (IDF) definitions. Follow-up time was median 5.5 years (interquartile range 3.7–6.7). Mortality data were complete, whereas morbidity data were available in 69% of the patients.

RESULTS The WHO definition was associated with a 2.1-fold increased risk of cardiovascular events and a 2.5-fold increased risk of cardiovascular- and diabetes-related mortality, after adjustment for traditional risk factors and diabetic nephropathy. The NCEP definition did not predict outcomes when adjusted for nephropathy but markedly added to the risk associated with elevated albuminuria alone (P < 0.001). The IDF definition did not predict outcomes.

CONCLUSIONS The metabolic syndrome is a risk factor, beyond albuminuria, for cardiovascular morbidity and diabetes-related mortality in type 1 diabetes.

Footnotes

↵*A complete list of the Finnish Diabetic Nephropathy (FinnDiane) Study Centers can be found in the online appendix at http://care.diabetesjournals.org/cgi/content/full/dc08-2022/DC1.
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- Received November 13, 2008.
- Accepted January 18, 2009.
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