Cardiovascular disease (CVD) is more frequent in adults with metabolic syndrome than in those without. We wished to assess the prevalence of the metabolic syndrome and the role of its specific components on prevalent CVD in a large cohort of subjects from the general population.
Methods:
Seventy-eight general practitioners among 3,542 were identified and participated in this study. Personal, anthropometric, and lifestyle data were obtained as was data relevant to CVD [coronary heart disease (CHD) or stroke or both]. A stratified random sample of 6,347 subjects taken from the population of the Veneto region in northeastern Italy was analyzed.
Results:
The prevalence [and its 95% confidence limits (CL)] of metabolic syndrome by gender and age classes was higher in men than women (21.9% vs. 16.8) and it increased with age (29.8% in ages 60–69 vs. 8.0 in ages 30–39). The most frequent triad of metabolic syndrome was waist circumference (WC)–blood pressure (BP)–hyperglycemia (GLYC) (33%). Metabolic syndrome was significantly associated with CVD [odds ratio (OR)=1.53, 95% CL, 1.02–2.29] and gender (men have about six times the risk of women), and the risk of CVD increases with age (11% per additional year of age). High-density lipoprotein (HDL) is the only component of metabolic syndrome associated with CVD: The OR was 2.12 (95% CL, 1.32–3.43) and remains significant in sex-specific models only in men.
Conclusions:
The prevalence of metabolic syndrome in the Veneto region among subjects ages 30–69 is high. There is a significant association between prevalent CVD and metabolic syndrome, but the biological basis of association is strongly influenced by gender.
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References
1.
FordES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: A summary of the evidence. Diabetes Care, 2005; 28:1769–1778.
2.
MalikS, WongND, FranklinSSet al.Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation, 2004; 110:1245–1250.
3.
ChurchTS, ThompsonAM, KatzmarzykPTet al.Metabolic syndrome and diabetes, alone and in combination, as predictors of cardiovascular disease mortality among men. Diabetes Care, 2009; 32:1289–1294.
4.
LorenzoC, WilliamsK, HuntKJet al.Trend in the prevalence of the metabolic syndrome and its impact on cardiovascular disease incidence: The San Antonio Heart Study. Diabetes Care, 2006; 29:625–630.
5.
LorenzoC, WilliamsK, HuntKJet al.The National Cholesterol Education Program Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care, 2007; 30:8–13.
6.
ButlerJ, RodondiN, ZhuYet al.Metabolic syndrome and the risk of cardiovascular disease in older adults. J Am Coll Cardiol, 2006; 47:1595–1602.
7.
JeppesenJ, HansenTW, RasmussenSet al.Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease: A population-based study. J Am Coll Cardiol, 2007; 49:2112–2119.
8.
WilsonPW, D'AgostinoRB, PariseHet al.Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation, 2005; 112:3066–3072.
9.
GinsbergHN, MacCallumPR. The obesity, metabolic syndrome, and type 2 diabetes mellitus pandemic: Part I. Increased cardiovascular disease risk and the importance of atherogenic dyslipidemia in persons with the metabolic syndrome and type 2 diabetes mellitus. J Cardiometab Syndr, 2009; 4:113–119.
10.
SattarN, McConnachieA, ShaperAGet al.Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies. Lancet, 2008; 371:1927–1935.
11.
HaringR, WallaschofskiH, NauckMet al.Total and cardiovascular disease mortality predicted by metabolic syndrome is inferior relative to its components. Exp Clin Endocrinol Diabetes, 2010; 118:685–691.
12.
GuptaAK, DahlofB, SeverPSet al.Metabolic syndrome, independent of its components, is a risk factor for stroke and death but not for coronary heart disease among hypertensive patients in the ASCOT-BPLA. Diabetes Care, 2010; 33:1647–1651.
13.
ReavenGM. The metabolic syndrome: Is this diagnosis necessary?Am J Clin Nutr, 2006; 83:1237–1247.
14.
ReavenGM. Insulin resistance, cardiovascular disease, and the metabolic syndrome: How well do the emperor's clothes fit?Diabetes Care, 2004; 27:1011–1012.
15.
FerranniniE. Is insulin resistance the cause of the metabolic syndrome?Ann Med, 2006; 38:42–51.
16.
MeigsJB, RutterMK, SullivanLMet al.Impact of insulin resistance on risk of type 2 diabetes and cardiovascular disease in people with metabolic syndrome. Diabetes Care, 2007; 30:1219–1225.
17.
MeigsJB, WilsonPW, NathanDMet al.in the San Antonio Heart and Framingham Offspring Studies. Diabetes, 2003; 52:2160–2167.
18.
SoneH, TanakaS, IimuroSet al.Components of metabolic syndrome and their combinations as predictors of cardiovascular disease in Japanese patients with type 2 diabetes. Implications for improved definition. Analysis from Japan Diabetes Complications Study (JDCS)J Atheroscler Thromb, 2009; 16:380–387.
19.
KnuimanMW, HungJ, DivitiniMLet al.Utility of the metabolic syndrome and its components in the prediction of incident cardiovascular disease: A prospective cohort study. Eur J Cardiovasc Prev Rehabil, 2009; 16:235–241.
20.
KokuboY, OkamuraT, YoshimasaYet al.Impact of metabolic syndrome components on the incidence of cardiovascular disease in a general urban Japanese population: The Suita Study. Hypertens Res, 2008; 31:2027–2035.
21.
AzevedoA, BettencourtP, AlmeidaPBet al.Increasing number of components of the metabolic syndrome and cardiac structural and functional abnormalities—cross-sectional study of the general population. BMC Cardiovasc Disord, 2007; 7:17.
22.
NakanishiN, TakatorigeT, FukudaHet al.Components of the metabolic syndrome as predictors of cardiovascular disease and type 2 diabetes in middle-aged Japanese men. Diabetes Res Clin Pract, 2004; 64:59–70.
23.
KleinBE, KleinR, LeeKE. Components of the metabolic syndrome and risk of cardiovascular disease and diabetes in Beaver Dam. Diabetes Care, 2002; 25:1790–1794.
24.
HanefeldM, KoehlerC, GalloSet al.Impact of the individual components of the metabolic syndrome and their different combinations on the prevalence of atherosclerotic vascular disease in type 2 diabetes: The Diabetes in Germany (DIG) study. Cardiovasc Diabetol, 2007; 6:13.
25.
NigamA, BourassaMG, FortierAet al.The metabolic syndrome and its components and the long-term risk of death in patients with coronary heart disease. Am Heart J, 2006; 151:514–521.
26.
FrancoOH, MassaroJM, CivilJet al.Trajectories of entering the metabolic syndrome: The framingham heart study. Circulation, 2009; 120:1943–1950.
27.
BonoraE, TargherG, FormentiniGet al.The metabolic syndrome is an independent predictor of cardiovascular disease in Type 2 diabetic subjects. Prospective data from the Verona Diabetes Complications Study. Diabet Med, 2004; 21:52–58.
28.
BonoraE, KiechlS, WilleitJet al.Carotid atherosclerosis and coronary heart disease in the metabolic syndrome: Prospective data from the Bruneck study. Diabetes Care, 2003; 26:1251–1257.
29.
FordES, GilesWH, DietzWH. Prevalence of the metabolic syndrome among US adults: Findings from the third National Health and Nutrition Examination Survey. JAMA, 2002; 287:356–359.
30.
BonoraE, KiechlS, WilleitJet al.Metabolic syndrome: Epidemiology and more extensive phenotypic description. Cross-sectional data from the Bruneck Study. Int J Obes Relat Metab Disord, 2003; 27:1283–1289.
31.
MiccoliR, BianchiC, OdoguardiLet al.Prevalence of the metabolic syndrome among Italian adults according to ATP III definition. Nutr Metab Cardiovasc Dis, 2005; 15:250–254.
ScholzeJ, AlegriaE, FerriCet al.Epidemiological and economic burden of metabolic syndrome and its consequences in patients with hypertension in Germany, Spain and Italy; a prevalence-based model. BMC Public Health, 2010; 10:529.
34.
ThanopoulouA, KaramanosB, AngelicoFet al.Epidemiological evidence for the non-random clustering of the components of the metabolic syndrome: Multicentre study of the Mediterranean Group for the Study of Diabetes. Eur J Clin Nutr, 2006; 60:1376–1383.
35.
GuizeL, PannierB, ThomasFet al.Recent advances in metabolic syndrome and cardiovascular disease. Arch Cardiovasc Dis, 2008; 101:577–583.
36.
KukJL, ArdernCI. Age and sex differences in the clustering of metabolic syndrome factors: Association with mortality risk. Diabetes Care, 2010; 33:2457–2461.
37.
SoneH, MizunoS, FujiiHet al.Is the diagnosis of metabolic syndrome useful for predicting cardiovascular disease in asian diabetic patients? Analysis from the Japan Diabetes Complications Study. Diabetes Care, 2005; 28:1463–1471.
38.
WirfältE, HedbladB, GullbergBet al.Food patterns and components of the metabolic syndrome in men and women: A cross-sectional study within the Malmö Diet and Cancer Cohort. Am J Epidemiol, 2001; 154:1150–1159.
39.
The DAISG. The prevalence of coronary heart disease in Type 2 diabetic patients in Italy: The DAI study. Diabetic Med, 2004; 21:738–745.
40.
Ilanne-ParikkaP, ErikssonJG, LindströmJet al.Prevalence of the metabolic syndrome and its components. Diabetes Care, 2004; 27:2135–2140.
41.
GersteinHC. Dysglycemia and cardiovascular risk in the general population. Circulation, 2009; 119:773–775.
42.
WritingC, UnwinN, ShawzJet al.Impaired glucose tolerance and impaired fasting glycaemia: The current status on definition and intervention. Diabetic Med, 2002; 19:708–723.
43.
MottilloS, FilionKB, GenestJet al.The metabolic syndrome and cardiovascular risk: A systematic review and meta-analysis. J Am Coll Cardiol, 2010; 56:1113–1132.
44.
GuzderRN, GatlingW, MulleeMAet al.Impact of metabolic syndrome criteria on cardiovascular disease risk in people with newly diagnosed type 2 diabetes. Diabetologia, 2006; 49:49–55.
45.
McCarthyJ, MeyerJ, MoliternoDet al.Evidence for substantial effect modification by gender in a large-scale genetic association study of the metabolic syndrome among coronary heart disease patients. Hum Genet, 2003; 114:87–98.
46.
KolovouGD, AnagnostopoulouKK, PavlidisANet al.Metabolic syndrome and gender differences in postprandial lipaemia. Eur J Cardiovasc Prev Rehabil, 2006; 13:661–664.
