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Metabolic syndrome and mortality in older adults: the Cardiovascular Health Study.
Tuesday,2012-11-06 12:09 America/Los_Angeles — eenright
| Title | Metabolic syndrome and mortality in older adults: the Cardiovascular Health Study. |
| Publication Type | Journal Article |
| Year of Publication | 2008 |
| Authors | Mozaffarian, D, Kamineni, A, Prineas, RJ, Siscovick, DS |
| Journal | Arch Intern Med |
| Volume | 168 |
| Issue | 9 |
| Pagination | 969-78 |
| Date Published | 2008 May 12 |
| ISSN | 1538-3679 |
| Keywords | Aged, Aged, 80 and over, Blood Glucose, Fasting, Female, Follow-Up Studies, Humans, Hypertension, Male, Metabolic Syndrome, Multivariate Analysis, Proportional Hazards Models, Prospective Studies, Risk Assessment, United States |
| Abstract | <p><b>BACKGROUND: </b>The utility of metabolic syndrome (MetS) for predicting mortality among older adults, the highest-risk population, is not well established. In addition, few studies have compared the predictive utility of MetS to that of its individual risk factors.</p><p><b>METHODS: </b>We evaluated relationships of MetS (as defined by the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [Adult Treatment Panel III (ATPIII)], International Diabetes Foundation [IDF], and World Health Organization [WHO]) and individual MetS criteria with mortality between 1989 and 2004 among 4258 US adults 65 years or older and free of prevalent cardiovascular disease (CVD) in the Cardiovascular Health Study, a multicenter, population-based, prospective cohort. Total, CVD, and non-CVD mortality were evaluated. Cox proportional hazards models were used to estimate the mortality hazard ratio (relative risk [RR]) predicted by MetS.</p><p><b>RESULTS: </b>At baseline (mean age, 73 years), 31% of men and 38% of women had MetS (ATPIII). During 15 years of follow-up, 2116 deaths occurred. After multivariable adjustment, compared with persons without MetS, those with MetS had a 22% higher mortality (RR, 1.22; 95% confidence interval [CI], 1.11-1.34). Higher risk with MetS was confined to persons having elevated fasting glucose level (EFG) (defined as > or = 110 mg/dL [> or = 6.1 mmol/L] or treated diabetes mellitus) (RR, 1.41; 95% CI, 1.27-1.57) or hypertension (RR, 1.26; 95% CI, 1.15-1.39) as one of the criteria; persons having MetS without EFG (RR, 0.97; 95% CI, 0.85-1.11) or MetS without hypertension (RR, 0.92; 95% CI, 0.71-1.19) did not have higher risk. Evaluating MetS criteria individually, we found that only hypertension and EFG predicted higher mortality; persons having both hypertension and EFG had 82% higher mortality (RR, 1.82; 95% CI, 1.58-109). Substantially higher proportions of deaths were attributable to EFG and hypertension (population attributable risk fraction [PAR%], 22.2%) than to MetS (PAR%, 6.3%). Results were similar when we used WHO or IDF criteria, when we evaluated different cut points of each individual criterion, and when we evaluated CVD mortality.</p><p><b>CONCLUSION: </b>These findings suggest limited utility of MetS for predicting total or CVD mortality in older adults compared with assessment of fasting glucose and blood pressure alone.</p> |
| DOI | 10.1001/archinte.168.9.969 |
| Alternate Journal | Arch Intern Med |
| PubMed ID | 18474761 |
| PubMed Central ID | PMC: N/A |
| Grant List | N01-HC-85085 / HC / NHLBI NIH HHS / United States R01 HL085710 / HL / NHLBI NIH HHS / United States N01-HC-85081 / HC / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States N01-HC-15103 / HC / NHLBI NIH HHS / United States N01-HC-85082 / HC / NHLBI NIH HHS / United States N01-HC-35129 / HC / NHLBI NIH HHS / United States N01-HC-85083 / HC / NHLBI NIH HHS / United States N01-HC-85080 / HC / NHLBI NIH HHS / United States K08-HL-075628 / HL / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States N01-HC-85084 / HC / NHLBI NIH HHS / United States |