Elsevier

Atherosclerosis

Volume 173, Issue 2, April 2004, Pages 307-312
Atherosclerosis

The metabolic syndrome and mortality from cardiovascular disease and all-causes: findings from the National Health and Nutrition Examination Survey II Mortality Study

https://doi.org/10.1016/j.atherosclerosis.2003.12.022Get rights and content

Abstract

The prospective associations between the metabolic syndrome as defined by the National Cholesterol Education Program (NCEP/ATP III) expert panel and mortality from cardiovascular disease and all-causes has not been extensively examined. Using data from the National Health and Nutrition Examination Survey II Mortality Study (1976–1992), the author examined the association between the metabolic syndrome and mortality from all-causes and cardiovascular disease among 2431 US adults aged 30–75 years. The NCEP/ATP III criteria were modified to substitute body mass index ≥25 kg/m2 for waist circumference for women and ≥30 kg/m2 for men. After multiple-adjustment, the hazard ratios for participants with the metabolic syndrome were 1.37 (95% confidence interval (CI): 1.02, 1.85) for mortality from cardiovascular disease, 1.29 (95% CI: 0.92, 1.82) for mortality from coronary heart disease, 1.68 (95% CI: 0.86, 3.27) for mortality from stroke, 1.23 (95% CI: 0.95, 1.59) for mortality from diseases of the circulatory system, and 1.15 (95% CI: 0.92, 1.45) for all-cause mortality compared with participants without the syndrome. The association between the number of metabolic syndrome criteria and mortality from cardiovascular disease was near linear (P=0.007). Three criteria of the syndrome—excess weight, hypertriglyceridemia, and low high-density lipoprotein cholesterol concentration—were not independently associated with any of the outcomes. Additional prospective studies are needed to examine the association between the metabolic syndrome and the incidence of cardiovascular disease and mortality from cardiovascular disease and all-causes.

Introduction

As early as 1923, Kylin recognized that hyperuricemia, hypertension, and hyperglycemia tended to occur together [1]. Although this early conceptualization of the metabolic syndrome has evolved considerably since that time, the exact nature of this syndrome remains a matter of debate. Researchers have usually included elements such as a measure of obesity, hypertension, hyperglycemia, dyslipidemia, insulin resistance in the many conceptualizations of this syndrome. In recent years, the World Health Organization and National Cholesterol Education Program (NCEP/ATP III) expert panel have proposed separate definitions of this syndrome [2], [3].

The prevalence of the metabolic syndrome using either of these definitions is very common in the United States [4], [5]. This high prevalence is of considerable concern because studies of the metabolic syndrome suggest that people with the metabolic syndrome are at increased risk for developing diabetes mellitus [6], [7], [8], [9] and cardiovascular disease and dying prematurely [10], [11], [12], [13], [14], [15]. However, the utility of the metabolic syndrome in predicting risk for the incidence and mortality of cardiovascular disease and all-cause mortality needs to be better understood. Such an understanding is one of the critical elements needed for formulating public health policy with regards to this syndrome. To provide additional insight into these risks in the US population, the author examined data from NHANES II Mortality Study.

Section snippets

Methods

From 1976 to 1980, about 28,000 persons aged 6 months to 74 years participated in NHANES II. The survey used a multistage sampling design so that the data would be representative of the non-institutionalized civilian population. After participants were interviewed at home, they were invited to have a medical examination during which they completed additional questionnaires, underwent a series of examinations and tests, and provided blood and urine specimens. Survey details have been published

Results

Glucose concentrations were measured for 3172 participants. After excluding participants who fasted <10 h, pregnant women, participants with missing data for any of the variables needed to determine the status of the metabolic syndrome, participants with missing values for other study variables, 2431 participants were available for analysis. These participants were followed for an average of 13.5 years. The prevalence of the metabolic syndrome was 24.0% (S.E. 1.1%) and the age-adjusted

Discussion

Unlike some other studies, the results from this study did not show a powerful increase in mortality from cardiovascular disease or all-causes. The clearest evidence for risk was the near linear association between the number of criteria for the metabolic syndrome and mortality from cardiovascular disease. However, when these criteria were grouped into the metabolic syndrome status, the association was more difficult to demonstrate. This may reflect the fact that the risk associated with not

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