Table 1—

Association between parameters for the metabolic syndrome (NCEP and WHO defined) and the metabolic syndrome with associated risk of mortality*

NCEP
WHO
Total mortalityCHD deathCVD deathTotal mortalityCHD deathCVD death
N = 9,677
    Metabolic syndrome (diabetes and obesity plus hypertension)2.5 (2.2–2.9)4.5 (3.4–6.1)3.3 (2.7–4.1)2.8 (2.4–3.2)4.1 (3.0–5.8)3.7 (3.0–4.7)
    Diabetes1.7 (1.4–1.9)1.9 (1.3–2.7)1.7 (1.4–2.2)1.7 (1.5–2.0)2.0 (1.4–2.8)1.8 (1.4–2.3)
    Obesity1.2 (1.1–1.4)1.3 (1.0–1.7)1.5 (1.3–1.8)1.1 (1.0–1.2)1.1 (0.9–1.4)1.2 (1.1–1.4)
    Hypertension§1.3 (1.2–1.4)1.3 (1.0–1.7)1.4 (1.2–1.7)1.3 (1.2–1.4)1.5 (1.2–1.9)1.5 (1.3–1.7)
Lipid subsample (n = 1,015)
    Metabolic syndrome (diabetes and obesity plus hypertension)1.7 (1.1–2.6)3.0 (1.4–6.6)2.3 (1.3–4.3)2.0 (1.2–3.1)3.2 (1.4–7.4)2.2 (1.1–4.5)
    Metabolic syndrome1.5 (1.2–1.8)2.0 (1.3–3.3)1.9 (1.3–2.6)2.0 (1.3–2.9)2.6 (1.2–5.6)2.0 (1.1–3.7)
    Metabolic syndrome vs. diabetes in lipid subsample
No diabetes, no metabolic syndrome(reference) n = 671(reference) n = 671(reference) n = 671(reference) n = 921(reference) n = 921(reference) n = 921
Metabolic syndrome but no diabetes1.3 (1.0–1.7) n = 2501.7 (1.0–3.0) n = 2501.6 (1.1–2.3) n = 250NANANA
Diabetes but no metabolic syndrome0.9 (0.5–1.9) n = 280.6 (0.1–4.7) n = 280.3 (0.0–2.4) n = 281.2 (0.7–2.0) n = 431.3 (0.4–4.0) n = 431.3 (0.6–2.9) n = 43
Diabetes plus metabolic syndrome2.1 (1.5–3.1) n = 663.3 (1.6–6.9) n = 662.8 (1.6–4.8) n = 662.0 (1.3–2.9) n = 512.6 (1.2–5.7) n = 512.0 (1.1–3.8) n = 51
  • Data are hazard ratios (95% CI), and significant hazards ratios are bolded.

  • *

    * All models are adjusted for age and smoking. Diabetes is physician diagnosed; measured glucose or insulin are not available. Obesity is defined by 1) waist circumference >88 cm (NCEP) or by 2) either waist-to-hip ratio >0.85 or BMI >30 kg/m2 (WHO). Hypertension is defined by measured blood pressure ≥130/85 (NCEP) or ≥140/90 mmHg (WHO). Elevated triglycerides are defined by triglycerides ≥150 mg/dl (NCEP and WHO), and low HDL cholesterol is defined by HDL <50 mg/dl (NCEP) and <39 mg/dl (WHO) (see refs. 17 and 19).

  • Diabetes models are adjusted for age, smoking, hypertension, and obesity by respective criteria.

  • Obesity models are adjusted for age, smoking, diabetes, and hypertension by respective criteria.

  • §

    § Hypertension models are adjusted for age, smoking, diabetes, and obesity by respective criteria.

  • The NCEP metabolic syndrome is defined by any three of the following defined parameters: diabetes, obesity, hypertension, elevated triglycerides, or low HDL; the WHO metabolic syndrome is defined as diabetes plus any two of the following defined parameters: obesity, hypertension, or abnormal lipids (triglycerides or HDL); the two definitions are not mutually exclusive (see refs. 17 and 19).

  • The prevalence of metabolic syndrome with NCEP increased from 4 to 31% by including abnormal lipid measures as one of three positive criteria for the metabolic syndrome and from 3 to 5% for WHO-defined metabolic syndrome (which requires a glucose abnormality).