Metabolic Syndrome as a Predictor of All-Cause and Cardiovascular Mortality in Type 2 Diabetes: The Casale Monferrato Study

Graziella Bruno; Franco Merletti; Annibale Biggeri; Giuseppe Bargero; Stefania Ferrero; Cristina Runzo; Stefano Prina Cerai; Gianfranco Pagano; Paolo Cavallo-Perin

doi:10.2337/diacare.27.11.2689

Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes

Metabolic Syndrome as a Predictor of All-Cause and Cardiovascular Mortality in Type 2 Diabetes

The Casale Monferrato Study

Graziella Bruno, MD1,
Franco Merletti, MD2,
Annibale Biggeri, MD3,
Giuseppe Bargero, MD4,
Stefania Ferrero, MD1,
Cristina Runzo, MD1,
Stefano Prina Cerai, MD1,
Gianfranco Pagano, MD1 and
Paolo Cavallo-Perin, MD1

¹Department of Internal Medicine, University of Turin, Turin, Italy
²Unit of Cancer Epidemiology, CERMS, and Center for Oncologic Prevention, University of Turin, Turin, Italy
³Department of Statistics G. Parenti, University of Florence, Florence, Italy
⁴Santo Spirito Hospital, Casale Monferrato, Alessandria, Italy

Address correspondence and reprint requests to Dr. Graziella Bruno, Department of Internal Medicine, University of Turin, corso Dogliotti 14, I-10126 Turin, Italy. E-mail: graziella.bruno{at}katamail.com

Diabetes Care 2004 Nov; 27(11): 2689-2694. https://doi.org/10.2337/diacare.27.11.2689

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Figure 1—
Prevalence of subjects with 0, 1, and 2 or more components of the metabolic syndrome () and of CHD (▪) at the baseline examination in the Casale Monferrato cohort of type 2 diabetes.

Tables

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Table 1—

Distribution of variables defying the metabolic syndrome in the Casale Monferrato cohort of type 2 diabetes

	Total
N	1,565
Four factors (n = 169)
Obesity + hypertension + dyslipidemia + elevated AER	169 (10.8)
Three factors (n = 468)
Obesity + hypertension + elevated AER	166 (10.6)
Obesity + hypertension + dyslipidemia	160 (10.2)
Hypertension + dyslipidemia + elevated AER	127 (8.1)
Obesity + dyslipidemia + elevated AER	15 (1.0)
Two factors (n = 549)
Hypertension + obesity	204 (13.0)
Hypertension + elevated AER	187 (11.9)
Hypertension + dyslipidemia	94 (6.0)
Obesity + dyslipidemia	21 (1.3)
Obesity + elevated AER	20 (1.3)
Dyslipidemia + elevated AER	23 (1.5)
One factor (n = 304)
Hypertension	202 (12.9)
Elevated AER	46 (2.9)
Obesity	28 (1.8)
Dyslipidemia	28 (1.8)
Diabetes only (n = 75)	75 (4.8)

Data are n (%).

Table 2—

All-cause and cardiovascular mortality rates in the Casale Monferrato cohort of type 2 diabetes by metabolic syndrome at baseline examination (1991–1992)

	All-cause mortality							Cardiovascular mortality
		n deaths (rate/1,000 person-years)	HR*	HR†	HR‡	n deaths (rate/1,000 person-years)	HR*	HR†	HR‡
Metabolic syndrome
No	165 (64.7)	1.00	1.00	1.00	85 (33.4)	1.00	1.00	1.00
Yes	520 (63.0)	1.05 (0.88–1.25)	1.04 (0.86–1.26)	1.06 (0.86–1.30)	256 (31.0)	1.01 (0.78–1.28)	1.04 (0.78–1.39)	0.95 (0.71–1.28)
Number of components
0	30 (58.7)	1.00	1.00	1.00	11 (21.5)	1.00	1.00	1.00
1	135 (66.2)	1.19 (0.76–1.86)	1.41 (0.86–2.31)	1.37 (0.83–2.25)	74 (36.3)	2.39 (1.09–5.22)	2.92 (1.16–7.33)	2.80 (1.11–7.11)
2	249 (68.3)	1.17 (0.76–1.81)	1.48 (0.90–2.33)	1.36 (0.85–2.21)	116 (31.8)	1.83 (0.85–3.97)	2.44 (0.99–6.06)	2.21 (0.89–5.49)
>2	271 (58.8)	1.07 (0.70–1.65)	1.36 (0.85–2.19)	1.25 (0.78–2.02)	140 (30.4)	2.10 (0.98–4.52)	2.80 (1.14–6.92)	2.46 (0.99–6.07)
P value for trend		0.62	0.35	0.93		0.12	0.69	0.40

Data are hazard ratios (HRs) (95% CI) unless otherwise indicated.
*
↵* Adjusted for age and sex;
†
↵† adjusted for age, sex, smoking, total cholesterol, and CHD;
‡
↵‡ adjusted for age, sex, smoking, total cholesterol, CHD, and HbA_1c cumulative average.