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Epidemiology/Health Services/Psychosocial Research

Cardiovascular Morbidity and Mortality Associated With the Metabolic Syndrome

  1. Bo Isomaa, MD1,
  2. Peter Almgren, MSC2,
  3. Tiinamaija Tuomi, MD3,
  4. Björn Forsén, MD4,
  5. Kaj Lahti, MD5,
  6. Michael Nissén, MD6,
  7. Marja-Riitta Taskinen, MD3 and
  8. Leif Groop, MD7
  1. 1Department of Internal Medicine, Jakobstad Hospital, Jakobstad, Finland
  2. 2Wallenberg laboratory, University of Lund, Malmö, Sweden
  3. 3Department of Medicine, Helsinki University Hospital, Helsinki
  4. 4Närpes Health Center, Närpes
  5. 5Vasa Health Center
  6. 6Department of Medicine, Vasa Central Hospital, Vasa, Finland
  7. 7Department of Endocrinology, Lund University, Malmö, Sweden
    Diabetes Care 2001 Apr; 24(4): 683-689. https://doi.org/10.2337/diacare.24.4.683
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    Article Figures & Tables

    Tables

    • Table 1 —

      Clinical and metabolic characteristics in 35–70-year-old subjects with NGT, IFG/IGT, and diabetic (type 2) glucose tolerance

      NGTIFG/IGTType 2 diabetes
      n (F/M)1,988 (1133/855)798 (397/401)1,697 (804/893)
      Age (years)50.5 ± 9.753.5 ± 10.058.6 ± 8.5
      BMI (kg/m2)25.9 ± 3.727.3 ± 4.429.5 ± 4.9
      WHR
       Men0.95 ± 0.060.96 ± 0.060.99 ± 0.06
       Women0.83 ± 0.070.84 ± 0.080.90 ± 0.07
      Fasting plasma glucose (mmol/l)5.4 ± 0.56.1 ± 0.69.8 ± 3.3
      HbA1c (%)5.3 ± 0.65.4 ± 0.67.5 ± 1.8
      Fasting insulin (mU/l)*7.5 ± 4.510.4 ± 6.015.2 ± 11.2
      HOMAIR*1.80 ± 1.132.83 ± 1.696.58 ± 5.87
      Cholesterol (mmol/l)5.7 ± 1.15.8 ± 1.15.8 ± 1.1
      HDL cholesterol (mmol/l)1.38 ± 0.361.27 ± 0.321.15 ± 0.3
      Triglycericdes (mmol/l)1.29 ± 0.801.58 ± 0.862.08 ± 1.60
      LDL cholesterol (mmol/l)3.77 ± 1.003.88 ± 0.993.78 ± 0.97
      Lipid-lowering medication 0.5 1.4 1.7
      Antihypertensive treatment15.521.946.3
      Systolic blood pressure†126.3 ± 16.2132.8 ± 16.6137.2 ± 17.0
      Diastolic blood pressure†77.9 ± 9.579.9 ± 9.580.5 ± 9.8
      History of MI
       Men 3.2 7.113.4
       Women 1.0 1.3 5.8
      Previous stroke 1.3 2.3 5.2
      Current smoking
       Men  23  17  16
       Women  12  12  11
      • Data are means ± SD and %, unless otherwise indicated.

      • *

        ↵* Insulin-treated patients excluded;

      • †

        ↵† only untreated patients.

    • Table 2 —

      Prevalence of the metabolic syndrome and the different components of the metabolic syndrome* in male and female subjects of different age decades with NGT, abnormal IFG/IGT, and diabetic glucose tolerance

      NGT
      IFG/IGT
      Type 2 diabetes†
      MaleFemaleMaleFemaleMaleFemale
      Metablic syndrome
       all 35–70 years151064428478
       40–49 years12659388778
       50–59 years20967448374
       60–69 years20‡19∥6652‡8481
      Obesity
       all 35–70 years763686519278
       40–49 years763487499580
       50–59 years813286569379
       60–69 years8044‡89539278
      Dyslipidemia
       all 35–70 years291645315456
       40–49 years311351256664
       50–59 years281746315551
       60–69 years2321‡3937‡50§57
      Hypertension
       all 35–70 years232431355559
       40–49 years201719314247
       50–59 years272941345553
       60–69 years35∥41∥39§47‡59§67∥
      Microalbuminuria
       all 35–70 years43762212
       40–49 years34161418
       50–59 years32881912
       60–69 years819‡92611
      Insulin resistance¶
       all 35–70 years252558598789
       40–49 years231953528789
       50–59 years282465578789
       60–69 years2935∥5968‡8690
      • Data are %.

      • *

        ↵* The definition of the metabolic syndrome was based on the recent WHO proposal (17);

      • †

        ↵† P < 0.001 for differences in all variables between subjects with diabetes and NGT/IFG/IGT when men and women aged 35–70 years were compared separately;

      • ‡

        ↵‡ P < 0.05;

      • §

        ↵§ P < 0.01;

      • ∥

        ↵∥ P < 0.001 when age decade 60–69 was compared to age decade 40–49;

      • ¶

        ¶ highest quartile of HOMAIR.

    • Table 3 —

      Prevalence of different combinations of the individual components of the metabolic syndrome* in 35–70-year-old male and female subjects with NGT, IFG/IGT, and diabetic glucose tolerance

      NGT
      IFG/IGT
      Type 2 diabetes
      MaleFemaleMaleFemaleMaleFemale
      Obesity + dyslipidemia25941215149
      Obesity + hypertension201128235050
      Obesity + hypertension + dyslipidemia7315102931
      Hypertension + dyslipidemia8516143136
      Obesity + microalbuminuria32632111
      Hypertension + microabluminuria22331610
      Dyslipidemia + microabluminuria1142149
      • Data are %.

      • *

        ↵* The definition of the metabolic syndrome was based on the recent WHO proposal (17).

    • Table 4 —

      Prevalence and RR of CHD*, MI, and stroke in relation to the presence of the metabolic syndrome†

      Metabolic syndrome
      RR‡P‡
      YesNo
      NGT (n = 1,808)
       CHD9.24.11.73 (1.01–2.95)0.04
       Previous MI3.11.61.24 (0.52–2.97)0.62
       Previous stroke2.21.61.31 (0.48–3.62)0.59
      IFG/IGT (n = 685)
       CHD11.05.31.82 (0.98–3.38)0.06
       Previous MI5.82.22.03 (0.81–5.08)0.13
       Previous stroke3.60.93.64 (1.01–13.13)0.05
      Type 2 DM (n = 1,430)
       CHD27.113.52.23 (1.52–3.26)<0.001
       Previous MI11.24.72.26 (1.25–4.10)0.007
       Previous stroke5.72.91.79 (0.85–3.79)0.13
      All subjects (n = 3,928)
       CHD21.45.52.96 (2.36–3.72)<0.001
       Previous MI9.02.12.63 (1.86–3.72)<0.001
       Previous stroke4.81.42.27 (1.47–3.50)<0.001
      • Data are % and RR (95% CI).

      • *

        ↵* Defined as typical chestpain/use of nitroglycerine/previous MI;

      • †

        ↵† definition of the syndrome was based on the recent WHO proposal (17);

      • ‡

        ↵‡ adjusted for age and sex.

    • Table 5 —

      Multiple logistic regression analysis with CHD, previous MI, or stroke as dependent variables and the metabolic syndrome and its components as independent variables in subjects with complete data

      Independent variablesCHD (n = 2,401)
      MI (n = 2,404)
      Stroke (n = 2,395)
      RRPRRPRRP
      The metabolic syndrome*2.96<0.0012.63<0.0012.27<0.001
      Obesity1.440.071.310.431.260.59
      Dyslipidemia1.73<0.0011.710.011.300.40
      Hypertension1.570.0021.310.221.340.34
      Microalbuminuria0.940.770.760.370.850.73
      Insulin resistance†1.530.012.020.0091.390.36
      • Adjusted for age and sex.

      • *

        ↵* The metabolic syndrome was defined based on the WHO proposal (17);

      • †

        ↵† defined as highest quartile of HOMA.

    • Table 6 —

      Multiple logistic regression anaysis with CHD as a dependent variable and the presence of the metabolic syndrome* or its individual components as independent variables in subjects with complete data (n = 2,401)

      NGT (n = 1,136)
      IFG/IGT (n = 488)
      Type 2 diabetes (n = 777)
      RRPRRPRRP
      The metabolic syndrome*1.730.041.820.062.23<0.001
      Obesity1.150.681.790.261.480.20
      Dyslipidemia1.680.131.340.411.840.001
      Hypertension2.33<0.0011.080.821.310.16
      Microabluminuria0.650.590.590.440.940.81
      Insulin resistance†1.130.712.180.060.760.34
      • Adjusted for age and sex.

      • *

        ↵* The metabolic syndrome was defined based on the recent WHO proposal (17);

      • †

        ↵† defined as the highest quartile of HOMA.

    • Table 7 —

      Multiple logistic regression analysis with cardiovascular mortality as a dependent variable and the metabolic syndrome* or its components as independent variables

      All subjects (209 deaths)
      Diabetic patients (168 deaths)
      RR (95% CI)PRR (95% CI)P
      The metabolic syndrome*1.81 (1.24–2.65)0.0021.15 (0.68–1.94)0.60
      Obesity1.10 (0.63–1.96)0.760.87 (0.43–1.76)0.70
      Dyslipidemia0.99 (0.63–1.58)0.980.93 (0.54–1.61)0.80
      Hypertension1.78 (1.09–2.91)0.021.43 (0.76–2.68)0.27
      Microalbuminuria2.80 (1.62–4.83)<0.0013.17 (1.70–5.91)<0.001
      Insulin resistance†1.53 (0.88–2.64)0.131.44 (0.56–3.71)0.45
      • Adjusted for age, sex, LDL cholesterol, and current smoking.

      • *

        ↵* The metabolic syndrome was defined based on the recent WHO proposal (17);

      • †

        ↵† defined as highest quartile of HOMAIR.

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    Cardiovascular Morbidity and Mortality Associated With the Metabolic Syndrome
    Bo Isomaa, Peter Almgren, Tiinamaija Tuomi, Björn Forsén, Kaj Lahti, Michael Nissén, Marja-Riitta Taskinen, Leif Groop
    Diabetes Care Apr 2001, 24 (4) 683-689; DOI: 10.2337/diacare.24.4.683

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    Cardiovascular Morbidity and Mortality Associated With the Metabolic Syndrome
    Bo Isomaa, Peter Almgren, Tiinamaija Tuomi, Björn Forsén, Kaj Lahti, Michael Nissén, Marja-Riitta Taskinen, Leif Groop
    Diabetes Care Apr 2001, 24 (4) 683-689; DOI: 10.2337/diacare.24.4.683
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