Cardiovascular Morbidity and Mortality
Cardiovascular Morbidity and Mortality
Objective: To estimate the prevalence of and the cardiovascular risk associated with the metabolic syndrome using the new definition proposed by the World Health Organization (WHO).
Research Design and Methods: A total of 4,483 subjects aged 35-70 years participating in a large family study of type 2 diabetes in Finland and Sweden (the Botnia study) were included in the analysis of cardiovascular risk associated with the metabolic syndrome. In subjects who had type 2 diabetes (n = 1,697), impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) (n = 798), or insulin-resistance with normal glucose tolerance (NGT) (n = 1,988), the metabolic syndrome was defined as presence of at least two of the following risk factors: obesity, hypertension, dyslipidemia, or microalbuminuria. Cardiovascular mortality was assessed in 3,606 subjects with a median follow-up of 6.9 years.
Results: In women and men, respectively, the metabolic syndrome was seen in 10 and 15% of subjects with NGT, 42 and 64% of those with IFG/IGT, and 78 and 84% of those with type 2 diabetes. The risk for coronary heart disease and stroke was increased threefold in subjects with the syndrome (P < 0.001). Cardiovascular mortality was markedly increased in subjects with the metabolic syndrome (12.0 vs. 2.2%, P < 0.001). Of the individual components of the metabolic syndrome, microalbuminuria conferred the strongest risk of cardiovascular death (RR 2.80; P = 0.002).
Conclusions The WHOdefinition of the metabolic syndrome identifies subjects with increased cardiovascular morbidity and mortality and offers a tool for comparison of results from different studies.
In 1988, Gerald Reaven reintroduced the concept of syndrome X for the clustering of cardiovascular risk factors like hypertension, glucose intolerance, high triglycerides, and low HDL cholesterol concentrations . The syndrome is, however, much older, having been already observed in 1923 by Kylin, who described the clustering of hypertension, hyperglycemia, and gout as a syndrome . Subsequently, several other metabolic abnormalities have been associated with this syndrome, including obesity, microalbuminuria, and abnormalities in fibrinolysis and coagulation . The syndrome has also been given several other names, including the metabolic syndrome, the insulin resistance syndrome, the plurimetabolic syndrome, and the deadly quartet . The name "insulin resistance syndrome" has been widely used and refers to insulin resistance as a common denominator of the syndrome . The prevalence of the metabolic syndrome has varied markedly between different studies, most likely because of the lack of accepted criteria for the definition of the syndrome . In 1998, WHO proposed a unifying definition for the syndrome and chose to call it the metabolic syndrome rather than the insulin resistance syndrome . This name was chosen primarily because it was not considered established that insulin resistance was the cause of all the components of the syndrome.
A unifying definition would allow us to assess whether the clustering of risk factors is associated with an increased risk of cardiovascular disease in addition to the risk associated with the individual components. Thus, the aim of the current study was to assess the prevalence of and cardiovascular morbidity and mortality associated with the metabolic syndrome by applying the WHO definition in a high-risk Scandinavian population.
Abstract and Introduction
Abstract
Objective: To estimate the prevalence of and the cardiovascular risk associated with the metabolic syndrome using the new definition proposed by the World Health Organization (WHO).
Research Design and Methods: A total of 4,483 subjects aged 35-70 years participating in a large family study of type 2 diabetes in Finland and Sweden (the Botnia study) were included in the analysis of cardiovascular risk associated with the metabolic syndrome. In subjects who had type 2 diabetes (n = 1,697), impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) (n = 798), or insulin-resistance with normal glucose tolerance (NGT) (n = 1,988), the metabolic syndrome was defined as presence of at least two of the following risk factors: obesity, hypertension, dyslipidemia, or microalbuminuria. Cardiovascular mortality was assessed in 3,606 subjects with a median follow-up of 6.9 years.
Results: In women and men, respectively, the metabolic syndrome was seen in 10 and 15% of subjects with NGT, 42 and 64% of those with IFG/IGT, and 78 and 84% of those with type 2 diabetes. The risk for coronary heart disease and stroke was increased threefold in subjects with the syndrome (P < 0.001). Cardiovascular mortality was markedly increased in subjects with the metabolic syndrome (12.0 vs. 2.2%, P < 0.001). Of the individual components of the metabolic syndrome, microalbuminuria conferred the strongest risk of cardiovascular death (RR 2.80; P = 0.002).
Conclusions The WHOdefinition of the metabolic syndrome identifies subjects with increased cardiovascular morbidity and mortality and offers a tool for comparison of results from different studies.
Introduction
In 1988, Gerald Reaven reintroduced the concept of syndrome X for the clustering of cardiovascular risk factors like hypertension, glucose intolerance, high triglycerides, and low HDL cholesterol concentrations . The syndrome is, however, much older, having been already observed in 1923 by Kylin, who described the clustering of hypertension, hyperglycemia, and gout as a syndrome . Subsequently, several other metabolic abnormalities have been associated with this syndrome, including obesity, microalbuminuria, and abnormalities in fibrinolysis and coagulation . The syndrome has also been given several other names, including the metabolic syndrome, the insulin resistance syndrome, the plurimetabolic syndrome, and the deadly quartet . The name "insulin resistance syndrome" has been widely used and refers to insulin resistance as a common denominator of the syndrome . The prevalence of the metabolic syndrome has varied markedly between different studies, most likely because of the lack of accepted criteria for the definition of the syndrome . In 1998, WHO proposed a unifying definition for the syndrome and chose to call it the metabolic syndrome rather than the insulin resistance syndrome . This name was chosen primarily because it was not considered established that insulin resistance was the cause of all the components of the syndrome.
A unifying definition would allow us to assess whether the clustering of risk factors is associated with an increased risk of cardiovascular disease in addition to the risk associated with the individual components. Thus, the aim of the current study was to assess the prevalence of and cardiovascular morbidity and mortality associated with the metabolic syndrome by applying the WHO definition in a high-risk Scandinavian population.
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