Table 2—

Information about studies that used the original or modified definition by the NCEP of the metabolic syndrome*

ReferenceStudySample sizeSexAge (years) (range or mean)Follow-up (years)OutcomesNo. of eventsRR (95% CI)Adjusted for
Studies of all-cause mortality
    Lakka 2002Kuopio Ischaemic Heart Disease Risk Factor Study, Finland1,209Men42–6011.4All-cause mortality1091.67 (0.91–3.08)Age, examination year, smoking, LDL cholesterol, family history of CHD, fibrinogen, white blood cell count, alcohol, socioeconomic status
    Katzmarzyk 2004Aerobics Center Longitudinal Study19,223Men20–8310.2All-cause mortality4800.98 (0.79–1.21)Age, smoking, alcohol, family history of CVD, cardiorespiratory fitness
    Hunt 2004San Antonio Heart Study2,815Men, women25–6412.7All-cause mortality2291.47 (1.13–1.92)Age, sex, race
    Ford 2004*National Health and Nutrition Examination Survey II Mortality Study2,431Men, women30–7513.5All-cause mortality5001.15 (0.92–1.45)Age, sex, race, education, smoking, non-HDL cholesterol, physical activity, white blood cell count, alcohol use, prevalent heart disease and stroke
Studies of CVD
    Onat 2002Turkish Adult Risk Factor Study, Turkey2,398Men, women≥283.0Angina pectoris, history of MI, electrocardiography, history of revascularization, fatal CHD1261.709 (1.180–2.473)Age
Men1.648 (0.981–2.768)Age
Women1.944 (1.108–3.411)Age
    Lakka 2002Kuopio Ischemic Heart Disease Risk Factor Study, Finland1,209Men42–6011.4CVD deaths (ICD-9 390–459)462.27 (0.96–5.36)Age, examination year, smoking, LDL cholesterol, family history of CHD, fibrinogen, white blood cell count, alcohol, socioeconomic status
CHD deaths (ICD-9 410–414)274.26 (1.62–11.2)Age, examination year, smoking, LDL cholesterol, family history of CHD, fibrinogen, white blood cell count, alcohol, socioeconomic status
    Resnick 2003Strong Heart Study2,283Men, women45–747.6Fatal MI, sudden death due to CHD, definite and possible fatal CHD, definite and possible fatal stroke, definite and possible fatal CHF, other fatal CVD1811.11 (0.79–1.56)Age, center, sex, BMI, fibrinogen, smoking, LDL cholesterol
    Katzmarzyk 2004Aerobics Center Longitudinal Study19,223Men20–8310.2CVD mortality (ICD-9 390–449.9)1611.23 (0.88–1.73)Age, smoking, alcohol, family history of CVD, cardiorespiratory fitness
    Bonora 2004Bruneck Study, Italy888Men, women40–795Fatal and nonfatal CHD (medical history, laboratory data, ECG, medical records, death certificates)461.5RR 1.5 Age, sex, smoking, alcohol, physical activity, social status, LDL cholesterol, baseline carotid atherosclerosis, baseline CHD
    Rutter 2004Framingham Offspring Study3,037Men, women26–826.9New-onset angina, fatal and nonfatal MI or stroke, TIA, heart failure, intermittent claudication1891.8 (1.4–2.5)Age, sex
    McNeill 2005Atherosclerosis Risk in Communities Study12,089Men, women45–6411Fatal or nonfatal hospitalized MI, fatal CHD, silent MI from electrocardiography, coronary revascularization879
5,208Men1.46 (1.23–1.74)Age, race, study center, LDL cholesterol, smoking
6,881Women2.05 (1.59–2.64)Age, race, study center, LDL cholesterol, smoking
Incident ischemic stroke216
5,208Men1.42 (0.96–2.11)Age, race, study center, LDL cholesterol, smoking
6,881Women1.96 (1.28–3.00)Age, race, study center, LDL cholesterol, smoking
    Hunt 2004San Antonio Heart Study2,815Men, women25–6412.7CVD mortality1172.53 (1.74–3.67)Age, sex, race
Not statedMenNot stated1.82 (1.14–2.91)Age, race
Not statedWomenNot stated4.65 (2.35–9.21)Age, race
    Ridker 2003*Women’s Health Study14,719Women≥458.0Nonfatal MI, nonfatal ischemic stroke, coronary revascularization, CV death
Not statedLow CRPNot stated2.3 (1.6–3.3)Age
Not statedHigh CRPNot stated4.0 (3.0–5.4)Age
Coronary eventsNot stated3.1 (2.0–4.9)Age
Not statedHigh CRPNot stated5.5 (3.8–8.0)Age
    Sattar 2003*West of Scotland Coronary Prevention Study, U.K.6,447Men55.1/55.24.9Nonfatal MI or CHD deathNot stated1.3 (1.00–1.67)Age, smoking, total cholesterol/HDLcholesterol, systolic blood pressure
Adding CRP and glucose did not change results
    Girman 2004*Air Force/Texas Coronary Atherosclerosis Prevention Study3,188Men, women585Fatal or nonfatal MI, sudden cardiac death, unstable angina1751.4 (1.04–1.89)Age
Fatal or nonfatal MI or strokeNot stated1.46 (1.003–2.1)Age
Fatal or nonfatal MINot stated1.49 (0.99–2.25)Age
    Ford 2004*National Health and Nutrition Examination Survey II Mortality Study2,431Men, women30–7513.5Mortality from diseases of the circulatory system (ICD-9 390–459)3171.23 (0.95–1.59)Age, sex, race, education, smoking, non-HDL cholesterol, physical activity, white blood cell count, alcohol use, prevalent heart disease and stroke
CVD mortality (ICD-9 410–414, 430–438)2001.37 (1.02–1.85)Age, sex, race, education, smoking, non-HDL cholesterol, physical activity, white blood cell count, alcohol use, prevalent heart disease and stroke
CHD mortality (ICD-9 410–414)1471.29 (0.92–1.82)Age, sex, race, education, smoking, non-HDL cholesterol, physical activity, white blood cell count, alcohol use, prevalent heart disease
Stroke mortality (ICD-9 430–438)671.68 (0.86–3.27)Age, sex, race, education, smoking, non-HDL cholesterol, physical activity, white blood cell count, alcohol use, prevalent heart disease and stroke
Studies of diabetes
    Laaksonen 2002Kuopio Ischemic Heart Disease Risk Factor Study, Finland958Men42–604FG ≥6.1 mmol/l, clinical diagnosis of diabetes with treatment516 (3.4–11.0)Age
    Resnick 2003Strong Heart Study2,283Men, women45–747.6Self-report, use of hypoglycemic agents, FG ≥126 mg/dl3891.95 (1.63–2.33)None
    Sattar 2003*West of Scotland Coronary Prevention Study, U.K.5,947Men55.1/55.24.9≥2 FG ≥7.0 mmol/l (one glucose measurement must be ≥2.0 mmol/l above baseline)Not stated3.51 (2.47–4.98)None
    Lorenzo 2003San Antonio Heart Study1,734Men, women25–687–8OGTT, medication use1953.3 (2.27–4.80)Age, sex, ethnicity, family history, impaired glucose tolerance, insulin
    Stern 2004Mexico City Diabetes Study, Mexico1,353Men, women35–646.3OGTT, medication use1252.63 (1.80–3.85)None
  • *

    * Studies that modified the NCEP definition of the metabolic syndrome by using BMI instead of waist circumference.

  • Approximated from figure.

  • Calculated from raw data. CHD, coronary heart disease; CHF, congestive heart failure; CRP, C-reactive protein; CVD, cardiovascular disease; FG, fasting glucose; MI, myocardial infarction; OGTT, oral glucose tolerance test; RR, relative risk; TIA, transient ischemic attack.