All-cause Mortality Associated with Specific Combinations of the Metabolic Syndrome According to Recent Definitions

Abstract

Objective: The aim was to evaluate the impact of specific component combinations of the metabolic syndrome (MetS) on all-cause mortality risk in a large French cohort.

Research Design and Methods: The population was composed of 39,998 (52.6±8.3 years) men and 20,756 (54.7±9.2 years) women, examined at the IPC Center from 1999 to 2002. Mean follow-up was 3.57±1.12 years. MetS was defined according to three definitions: the National Cholesterol Educational Program (NCEP 2001), the revised NCEP (NCEP-R, AHA/NHLBI 2005), and the International Diabetes Federation (IDF 2005). Subjects with MetS were compared to subjects without MetS, and to subjects with no MetS components, using Cox regression models.

Results: The prevalence of MetS increased from 10.3% (NCEP) to 17.7% (NCEP-R) and 23.4% (IDF). After adjustment for age, gender, classical risk factors and socioprofessional categories, and compared to subjects without MetS, the risk of all-cause mortality was 1.79 (1.35-2.38), 1.46 (1.14-1.88) and 1.32 ( 1.04-1.67) with the NCEP, NCEP-R and IDF definitions, respectively. Among the combinations significantly associated with all-cause mortality, the following three-component combinations and four-component combination were more highly significant than other combinations (p<0.05): elevated waist circumference plus elevated glucose, plus either elevated blood pressure or elevated triglycerides, and the combination of all four of these.

Conclusions: In a large middle-aged French population, four specific components of MetS are associated with a much higher mortality risk. These results may have a significant impact on detecting ‘high risk' subjects suffering from metabolic disorders and underline the fact that MetS is a non-homogeneous syndrome.