Does diagnosis of the metabolic syndrome detect further men at high risk of cardiovascular death beyond those identified by a conventional cardiovascular risk score? The DECODE Study: The Diabetes Epidemiology: Collaborative analysis Of Diagnostic Criteria in Europe (DECODE) Study Group

Abstract

Background

It is not known whether the metabolic syndrome detects further individuals at high risk of death from cardiovascular disease (CVD), beyond those identified by a conventional cardiovascular risk score.

Design

A prospective study.

Methods

A total of 2790 men without diabetes, aged 50–69 years from seven population-based European cohorts participating in the DECODE Study, were followed for CVD mortality over 10 years.

Results

Some 51% of the men had an estimated 10-year risk of fatal CVD under 5%, using the European SCORE project equation, and 22% of them had the metabolic syndrome, as defined by the National Cholesterol Education Program Adult Treatment Panel III. In the low-risk men, the hazards ratio for fatal CVD, after adjusting for age and study centre, was 2.71 (1.33–5.51) for men with the syndrome (P<0.01) compared with men without the syndrome. A large waist circumference (>102cm) carried an odds ratio of 2.24 (1.05–4.76) in the low CVD risk men.

Conclusions

Men with a low cardiovascular risk score and the metabolic syndrome had a significantly higher risk of fatal CVD than those without the syndrome. The use of the metabolic syndrome in clinical practice is thus justified in men, but waist circumference provided a simpler diagnostic tool with similar fatal CVD risk in these low-risk men. A large waist circumference could be used for prescreening, and could be included in CVD risk scores.