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Metabolic Syndrome and Risk of Cardiovascular Disease: A Meta-Analysis

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Abstract

Purpose

The use of different definitions of the metabolic syndrome has led to inconsistent results on the association between the metabolic syndrome and risk of cardiovascular disease. We examined the association between the metabolic syndrome and risk of cardiovascular disease.

Methods

A MEDLINE search (1966-April 2005) was conducted to identify prospective studies that examined the association between the metabolic syndrome and risk of cardiovascular disease. Information on sample size, participant characteristics, metabolic syndrome definition, follow-up duration, and endpoint assessment was abstracted.

Results

Data from 21 studies met the inclusion criteria and were included. Individuals with the metabolic syndrome, compared to those without, had an increased mortality from all causes (relative risk [RR] 1.35; 95% confidence interval [CI], 1.17-1.56) and cardiovascular disease (RR 1.74; 95% CI, 1.29-2.35); as well as an increased incidence of cardiovascular disease (RR 1.53; 95% CI, 1.26-1.87), coronary heart disease (RR 1.52; 95% CI, 1.37-1.69) and stroke (RR 1.76; 95% CI, 1.37-2.25). The relative risk of cardiovascular disease associated with the metabolic syndrome was higher in women compared with men and higher in studies that used the World Health Organization definition compared with studies that used the Adult Treatment Panel III definition.

Conclusion

This analysis strongly suggests that the metabolic syndrome is an important risk factor for cardiovascular disease incidence and mortality, as well as all-cause mortality. The detection, prevention, and treatment of the underlying risk factors of the metabolic syndrome should become an important approach for the reduction of the cardiovascular disease burden in the general population.

Section snippets

Study Selection

An extensive literature search of the MEDLINE database (1966 to April 2005) was conducted using the Medical Subject Headings metabolic syndrome, syndrome X, cardiovascular diseases, and cohort studies. The search was restricted to studies conducted in human subjects. In addition, a manual search of citations from relevant original studies and review articles was performed. The contents of 120 abstracts or full-text manuscripts identified during the literature search were reviewed independently

Results

A total of 21 prospective cohort studies were included in this meta-analysis. Characteristics of the 21 studies and their participants are presented in Table 1. Among the 21 studies, 11 were conducted in the US and 10 in Europe. The number of participants ranged from 318 to 19,223. The ATP III criteria were used in 16 studies, whereas the WHO criteria were used in 5 studies. Two studies used both criteria. Prevalence of the metabolic syndrome varied from 8.8% to 92.3%. However, the highest

Discussion

Diabetes, dyslipidemia, hypertension and obesity are well-known major cardiovascular risk factors. Many studies on the association of the metabolic syndrome and risk of cardiovascular disease have been published in recent years. Given the modifiable nature of the individual components and the increasing prevalence of the metabolic syndrome, research on the metabolic syndrome and ways to reduce the risk of cardiovascular disease is mandatory to develop better prevention strategies.

Our

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    Supported in part by grant number K12HD43451 from the National Institutes of Health to Dr. Reynolds.

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