Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Oct 28;15(1):149.
doi: 10.1186/s12933-016-0466-6.

Metabolic syndrome is independently associated with increased 20-year mortality in patients with stable coronary artery disease

Arwa Younis  1 , Anan Younis  2 , Boaz Tzur  2 , Yael Peled  2 , Nir Shlomo  2 , Ilan Goldenberg  2   3   4 , Enrique Z Fisman  3   5 , Alexander Tenenbaum  2   3   5 , Robert Klempfner  2   3
Affiliations

Metabolic syndrome is independently associated with increased 20-year mortality in patients with stable coronary artery disease

Arwa Younis et al. Cardiovasc Diabetol. .

Abstract

Background: Data regarding long-term association of metabolic syndrome (MetS) with adverse outcomes are conflicting. We aim to determine the independent association of MetS (based on its different definitions) with 20 year all-cause mortality among patients with stable coronary artery disease (CAD).

Methods: Our study comprised 15,524 patients who were enrolled in the Bezafibrate Infarction Prevention registry between February 1, 1990, and October 31, 1992, and subsequently followed-up for the long-term mortality through December 31, 2014. MetS was defined according to two definitions: The International Diabetes Federation (IDF); and the National Cholesterol Education Program-Third Adult Treatment Panel (NCEP).

Results: According to the IDF criteria 2122 (14%) patients had MetS, whereas according to the NCEP definition 7446 (48%) patients had MetS. Kaplan-Meier survival analysis showed that all-cause mortality was significantly higher among patients with MetS defined by both the IDF (67 vs. 61%; log rank-p < 0.001) as well as NCEP (67 vs. 54%; log rank-p < 0.001) criteria. Multivariate adjusted mortality risk was 17% greater [Hazard Ratio (HR) 1.17; 95% Confidence Interval (CI) 1.07-1.28] in patients with MetS according to IDF and 21% (HR 1.21; 95% CI 1.13-1.29) using the NCEP definition. Subgroup analysis demonstrated that long-term increased mortality risk associated with MetS was consistent among most clinical subgroups excepted patients with renal failure (p value for interaction < 0.05).

Conclusions: Metabolic syndrome is independently associated with an increased 20-year all-cause mortality risk among patients with stable CAD. This association was consistent when either the IDF or NCEP definitions were used. Trial registration retrospective registered.

Keywords: All-cause mortality; Long term outcomes; Metabolic syndrome; Prognosis; Stable coronary artery disease.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Kaplan-Meier 20-year survival estimates for the entire cohort. a Survival estimates according to the presence or absence of the metabolic syndrome according to the IDF definition. b Survival estimates according to the presence or absence of metabolic syndrome according to the NCEP definition. Cre creatinine; DM diabetes mellitus; IDF International Diabetes Federation; LDL low density lipoprotein; MetS metabolic syndrome; MI myocardial infarction; NCEP National Cholesterol Educational Program
Fig. 2
Fig. 2
Mortality risk associated with metabolic syndrome presence according to the IDF (a) and NCEP definitions (b) in pre-specified subgroups. Both models further adjusted for: hypertension, smoking status, and severe heart failure (NYHA >2). Cre creatinine; DM diabetes mellitus; IDF International Diabetes Federation; LDL low density lipoprotein; MetS metabolic syndrome; MI myocardial infarction; NCEP National Cholesterol Educational Program
See this image and copyright information in PMC

References

    1. Wilson PW, Grundy SM. The metabolic syndrome: practical guide to origins and treatment: Part I. Circulation. 2003;108(12):1422–1424. doi: 10.1161/01.CIR.0000089505.34741.E5. - DOI - PubMed
    1. Wilson PW, Grundy SM. The metabolic syndrome: a practical guide to origins and treatment: Part II. Circulation. 2003;108(13):1537–1540. doi: 10.1161/01.CIR.0000089506.12223.F1. - DOI - PubMed
    1. Ford ES. Prevalence of the metabolic syndrome in US populations. Endocrinol Metab Clin North Am. 2004;33(2):333–350. doi: 10.1016/j.ecl.2004.03.004. - DOI - PubMed
    1. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among US Adults. Diabetes Care. 2004;27(10):2444–2449. doi: 10.2337/diacare.27.10.2444. - DOI - PubMed
    1. Hu G, Lindstrom J, Jousilahti P, Peltonen M, Sjoberg L, Kaaja R, Sundvall J, Tuomilehto J. The increasing prevalence of metabolic syndrome among Finnish men and women over a decade. J Clin Endocrinol Metab. 2008;93(3):832–836. doi: 10.1210/jc.2007-1883. - DOI - PubMed

MeSH terms