CLINICAL RESEARCH: HYPERLIPIDEMIA AND METABOLIC SYNDROME
Metabolic Syndrome and the Risk of Cardiovascular Disease in Older Adults
Javed Butler, MD, MPH, FACC*,*,
Nicolas Rodondi, MD, MAS||,
Yuwei Zhu, PhD ,
Kathleen Figaro, MD, MS ,
Sergio Fazio, MD, PhD*,
Douglas E. Vaughan, MD, FACC*,
Suzanne Satterfield, MD ,
Anne B. Newman, MD, MPH#,
Bret Goodpaster, PhD#,
Douglas C. Bauer, MD||,
Paul Holvoet, PhD**,
Tamara B. Harris, MD, MS,
Nathalie de Rekeneire, MD,
Susan Rubin, MPH¶,
Jingzhong Ding, PhD,
Stephen B. Kritchevsky, PhD for the Health ABC Study
* Division of Cardiovascular Medicine, Vanderbilt University, Nashville, Tennessee
Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
Division of General Internal Medicine, Vanderbilt University, Nashville, Tennessee
Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee
|| Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
¶ Prevention Sciences Group, University of California San Francisco, San Francisco, California
# Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
** Center for Experimental Surgery and Anesthesiology, Catholic University, Leuven, Belgium
Laboratory of Epidemiology, Demography and Biometry, National Institute of Aging, National Institutes of Health, Bethesda, Maryland
Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Manuscript received August 24, 2005;
revised manuscript received December 1, 2005,
accepted December 5, 2005.
* Reprint requests and correspondence: Dr. Javed Butler, Cardiology Division, 383-PRB, Vanderbilt University Medical Center, Nashville, Tennessee 37232 (Email: javed.butler{at}vanderbilt.edu).
OBJECTIVES: The purpose of this study was to assess whether metabolic syndrome (MetSyn) predicts a higher risk for cardiovascular events in older adults.
BACKGROUND: The importance of MetSyn as a risk factor has not previously focused on older adults and deserves further study.
METHODS: We studied the impact of MetSyn (38% prevalence) on outcomes in 3,035 participants in the Health, Aging, and Body Composition (Health ABC) study (51% women, 42% black, ages 70 to 79 years).
RESULTS: During a 6-year follow-up, there were 434 deaths overall, 472 coronary events (CE), 213 myocardial infarctions (MI), and 231 heart failure (HF) hospital stays; 59% of the subjects had at least one hospital stay. Coronary events, MI, HF, and overall hospital stays occurred significantly more in subjects with MetSyn (19.9% vs. 12.9% for CE, 9.1% vs. 5.7% for MI, 10.0% vs. 6.1% for HF, and 63.1% vs. 56.1% for overall hospital stay; all p < 0.001). No significant differences in overall mortality was seen; however, there was a trend toward higher cardiovascular mortality (5.1% vs. 3.8%, p = 0.067) and coronary mortality (4.5% vs. 3.2%, p = 0.051) in patients with MetSyn. After adjusting for baseline characteristics, patients with MetSyn were at a significantly higher risk for CE (hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.28 to 1.91), MI (HR 1.51, 95% CI 1.12 to 2.05), and HF hospital stay (HR 1.49, 95% CI 1.10 to 2.00). Women and whites with MetSyn had a higher coronary mortality rate. The CE rate was higher among subjects with diabetes and with MetSyn; those with both had the highest risk.
CONCLUSIONS: Overall, subjects over 70 years are at high risk for cardiovascular events; MetSyn in this group is associated with a significantly greater risk.
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Abbreviations and Acronyms
| | CE = coronary event | | CHD = coronary heart disease | | CI = confidence interval | | Health ABC = Health, Aging, and Body Composition study | | HF = heart failure | | HR = hazard ratio | | MetSyn = metabolic syndrome | | MI = myocardial infarction |
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