The clinical value of metabolic syndrome and risks of cardiometabolic events and mortality in the elderly: the Rotterdam study

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Abstract

Background

To evaluate the clinical value of metabolic syndrome based on different definitions [American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI), International Diabetes Federation (IDF) and European Group for the Study of Insulin Resistance (EGIR)] in middle-aged and elderly populations.

Methods

We studied 8643 participants from the Rotterdam study (1990–2012; mean age 62.7; 57.6 % female), a large prospective population-based study with predominantly elderly participants. We performed cox-proportional hazards models for different definitions, triads within definitions and each separate component for the risk of incident type 2 diabetes mellitus, coronary heart disease, stroke, cardiovascular- and all-cause mortality.

Results

In our population of 8643 subjects, metabolic syndrome was highly prevalent (prevalence between 19.4 and 42.4 %). Metabolic syndrome in general was associated with incident type 2 diabetes mellitus (median follow-up of 6.8 years, hazard ratios 3.13–3.78). The associations with coronary heart disease (median follow-up of 7.2 years, hazard ratios 1.08–1.32), stroke (median follow-up of 7.7 years, hazard ratios 0.98–1.32), cardiovascular mortality (median follow-up of 8.2 years, ratios 0.95–1.29) and all-cause mortality (median follow-up of 8.7 years, hazard ratios 1.05–1.10) were weaker. AHA/NHLBI- and IDF-definitions showed similar associations with clinical endpoints compared to the EGIR, which was only significantly associated with incident type 2 diabetes mellitus. All significant associations disappeared after correcting metabolic syndrome for its individual components.

Conclusions

Large variability exists between and within definitions of the metabolic syndrome with respect to risk of clinical events and mortality. In a relatively old population the metabolic syndrome did not show an additional predictive value on top of its individual components. So, besides as a manner of easy identification of high risk patients, the metabolic syndrome does not seem to add any predictive value for clinical practice.

Electronic supplementary material

The online version of this article (doi:10.1186/s12933-016-0387-4) contains supplementary material, which is available to authorized users.

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Most cited references 33

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Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies.

Apoor Gami, Brandi Witt, Daniel E. Howard … (2007)

The purpose of this research was to assess the association between the metabolic syndrome (MetSyn) and cardiovascular events and mortality by meta-analyses of longitudinal studies. Controversy exists regarding the cardiovascular risk associated with MetSyn. We searched electronic reference databases through March 2005, studies that referenced Reaven's seminal article, abstracts presented at meetings in 2003 to 2004, and queried experts. Two reviewers independently assessed eligibility. Longitudinal studies reporting associations between MetSyn and cardiovascular events or mortality were eligible. Two reviewers independently used a standardized form to collect data from published reports. Authors were contacted. Study quality was assessed by the control of selection, detection, and attrition biases. We found 37 eligible studies that included 43 cohorts (inception 1971 to 1997) and 172,573 individuals. Random effects meta-analyses showed MetSyn had a relative risk (RR) of cardiovascular events and death of 1.78 (95% confidence interval [CI] 1.58 to 2.00). The association was stronger in women (RR 2.63 vs. 1.98, p = 0.09), in studies enrolling lower risk (<10%) individuals (RR 1.96 vs. 1.43, p = 0.04), and in studies using factor analysis or the World Health Organization definition (RR 2.68 and 2.06 vs. 1.67 for National Cholesterol Education Program definition and 1.35 for other definitions; p = 0.005). The association remained after adjusting for traditional cardiovascular risk factors (RR 1.54, 95% CI 1.32 to 1.79). The best available evidence suggests that people with MetSyn are at increased risk of cardiovascular events. These results can help clinicians counsel patients to consider lifestyle interventions, and should fuel research of other preventive interventions.

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Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence.

E. Ford (2005)

In recent years, several major organizations have endorsed the concept of the metabolic syndrome and developed working definitions for it. How well these definitions predict the risk for adverse events in people with the metabolic syndrome is only now being learned. The purpose of this study was to summarize the estimates of relative risk for all-cause mortality, cardiovascular disease, and diabetes reported from prospective studies in samples from the general population using definitions of the metabolic syndrome developed by the National Cholesterol Education Program (NCEP) and World Health Organization (WHO). The author reviewed prospective studies from July 1998 through August 2004. For studies that used the exact NCEP definition of the metabolic syndrome, random-effects estimates of combined relative risk were 1.27 (95% CI 0.90-1.78) for all-cause mortality, 1.65 (1.38-1.99) for cardiovascular disease, and 2.99 (1.96-4.57) for diabetes. For studies that used the most exact WHO definition of the metabolic syndrome, the fixed-effects estimates of relative risk were 1.37 (1.09-1.74) for all-cause mortality and 1.93 (1.39-2.67) for cardiovascular disease; the fixed-effects estimate was 2.60 (1.55-4.38) for coronary heart disease. These estimates suggest that the population-attributable fraction for the metabolic syndrome, as it is currently conceived, is approximately 6-7% for all-cause mortality, 12-17% for cardiovascular disease, and 30-52% for diabetes. Further research is needed to establish the use of the metabolic syndrome in predicting risk for death, cardiovascular disease, and diabetes in various population subgroups.

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Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S.

Earl S. Ford (2005)

The International Diabetes Federation (IDF) has proposed a new definition of the metabolic syndrome that emphasizes central adiposity as determined by ethnic group-specific thresholds of waist circumference. The objective of this study was to estimate the prevalence of this syndrome using the IDF definition among U.S. adults and to compare it with the prevalence estimated using the definition of the National Cholesterol Education Program (NCEP). A total of 3,601 men and women aged > or =20 years from the National Health and Nutrition Examination Survey 1999-2002 were included in the analyses. Based on the NCEP definition, the unadjusted prevalence of the metabolic syndrome was 34.5 +/- 0.9% (percent +/- SE) among all participants, 33.7 +/- 1.6% among men, and 35.4 +/- 1.2% among women. Based on the IDF definition, the unadjusted prevalence of the metabolic syndrome was 39.0 +/- 1.1% among all participants, 39.9 +/- 1.7% among men, and 38.1 +/- 1.2% among women. The IDF definition led to higher estimates of prevalence in all of the demographic groups, especially among Mexican-American men. The two definitions similarly classified approximately 93% of the participants as having or not having the metabolic syndrome. In the U.S., the use of the IDF definition of the metabolic syndrome leads to a higher prevalence estimate of the metabolic syndrome than the estimate based on the NCEP definition.

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Author and article information

Contributors

Thijs T. W. van Herpt: t.vanherpt@erasmusmc.nl

Abbas Dehghan: +31 10 7043997 , a.dehghan@erasmusmc.nl

Mandy van Hoek: m.vanhoek@erasmusmc.nl

M. Arfan Ikram: m.a.ikram@erasmusmc.nl

Albert Hofman: a.hofman@erasmusmc.nl

Eric J. G. Sijbrands: e.sijbrands@erasmusmc.nl

Oscar H. Franco: o.franco@erasmusmc.nl

Journal

Journal ID (nlm-ta): Cardiovasc Diabetol

Journal ID (iso-abbrev): Cardiovasc Diabetol

Title: Cardiovascular Diabetology

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-2840

Publication date (Electronic): 27 April 2016

Publication date PMC-release: 27 April 2016

Publication date Collection: 2016

Volume: 15

Electronic Location Identifier: 69

Affiliations

[ ]Department of Epidemiology, Erasmus Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands

[ ]Department of Internal Medicine, Erasmus Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands

[ ]Department of Neurology, Erasmus Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands

[ ]Department of Radiology, Erasmus Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands

Article

Publisher ID: 387

DOI: 10.1186/s12933-016-0387-4

PMC ID: 4847340

PubMed ID: 27117940

SO-VID: 616c069f-7e8f-410d-b170-bd7b13203c77

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 28 November 2015

Date accepted : 13 April 2016

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001826, ZonMw;

Award ID: veni 916.12.154

Award Recipient : Abbas Dehghan

Custom metadata

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: metabolic syndrome,cardiovascular disease,diabetes mellitus,stroke,cardiovascular mortality,all-cause mortality,preventive medicine,rotterdam study

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ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: metabolic syndrome, cardiovascular disease, diabetes mellitus, stroke, cardiovascular mortality, all-cause mortality, preventive medicine, rotterdam study

The clinical value of metabolic syndrome and risks of cardiometabolic events and mortality in the elderly: the Rotterdam study

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Journal of the ASEAN Federation of Endocrine Societies

Most cited references 33

Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies.

Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence.

Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S.

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