Increased Mortality Associated With the Metabolic Syndrome in Older Women With Diabetes
- Teresa A. Hillier, MD1,
- Joanne H. Rizzo, MA1,
- Kathryn L. Pedula, MS1,
- Jane A. Cauley, DRPH2,
- Ann V. Schwartz, PHD3,
- Kristine E. Ensrud, MD4 and
- Warren S. Browner, MD5
- 1Center for Health Research, Kaiser Permanente Northwest/Hawaii, Portland, Oregon
- 2Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
- 3Department of Epidemiology and Biostatistics, University of California, San Francisco, California
- 4Department of Medicine, Minneapolis Veterans Affairs Medical Center and the Department of Medicine and Division of Epidemiology, University of Minnesota, Minneapolis, Minnesota
- 5California Pacific Medical Center Research Institute, San Francisco, California
- Address correspondence and reprint requests to Teresa A. Hillier, MD, MS, Center for Health Research, Kaiser Permanente Northwest/Hawaii, 3800 N. Interstate Ave., Portland, OR 97227. E-mail: teresa.hillier{at}kp.org
- CHD, coronary heart disease
- CVD, cardiovascular disease
- NCEP, National Cholesterol Education Panel
- SOF, Study of Osteoporotic Fractures
- WHO, World Health Organization
About 25% of U.S. adults have the metabolic syndrome (1), a cluster of central obesity; abnormal glucose, insulin, and lipids; and hypertension. Clinicians and the media have increasingly emphasized its diagnosis and treatment (2,3). Several recent prospective studies associate increased cardiovascular disease (CVD) or total mortality risk with the metabolic syndrome in men and younger adults (4–10). Over 90% of CVD mortality in women occurs after 65 years of age (11), and women with diabetes lose sex-protective effects; their CVD relative risk is even greater than men with diabetes (12). Whether the metabolic syndrome increases mortality risk in addition to diabetes is unclear. We prospectively evaluated the syndrome’s association with CVD mortality in older women and whether its risk is greater than diabetes alone.
RESEARCH DESIGN AND METHODS
From 1986 to 1988, the Study of Osteoporotic Fractures (SOF) recruited 9,704 community-dwelling women, ≥65 years of age (>99% Non-Hispanic White) in four U.S. regions: Baltimore County, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela Valley near Pittsburgh, Pennsylvania (13). Women unable to walk without assistance and those with bilateral hip replacements were excluded. All participants provided written consent, and SOF was approved by each site’s institutional review board.
Waist and hip circumference were measured by standardized protocol (14) to the nearest 0.10 cm with steel tape. Weight was measured by balance beam, height by stadiometer. Blood pressure was measured supine and after standing 1 min; the average …
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