REVIEW AND META-ANALYSIS
Metabolic Syndrome and Risk of Incident Cardiovascular Events and Death
A Systematic Review and Meta-Analysis of Longitudinal Studies
Apoor S. Gami, MD*, ,*,
Brandi J. Witt, MD*, ,
Daniel E. Howard, MD ,
Patricia J. Erwin, MLS ,
Lisa A. Gami, RN*, ,
Virend K. Somers, MD, PhD, FACC*, , and
Victor M. Montori, MD, MSc ,||,¶
* Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota
Division of Hypertension, Mayo Clinic College of Medicine, Rochester, Minnesota
|| Division of Endocrinology, Nutrition, and Metabolism, Mayo Clinic College of Medicine, Rochester, Minnesota
¶ Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, Minnesota.
Manuscript received June 26, 2006;
revised manuscript received September 1, 2006,
accepted September 27, 2006.
* Reprint requests and correspondence: Dr. Apoor S. Gami, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905. (Email: gami.apoor{at}mayo.edu).
OBJECTIVES: 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.
BACKGROUND: Controversy exists regarding the cardiovascular risk associated with MetSyn.
METHODS: We searched electronic reference databases through March 2005, studies that referenced Reavens 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.
RESULTS: 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).
CONCLUSIONS: 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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Abbreviations and Acronyms
| | CI = confidence interval | | MetSyn = metabolic syndrome | | NCEP = National Cholesterol Education Program | | RR = relative risk | | WHO = World Health Organization |
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Q. Qiao, T. Laatikainen, B. Zethelius, B. Stegmayr, M. Eliasson, P. Jousilahti, and J. Tuomilehto
Comparison of Definitions of Metabolic Syndrome in Relation to the Risk of Developing Stroke and Coronary Heart Disease in Finnish and Swedish Cohorts
Stroke,
February 1, 2009;
40(2):
337 - 343.
[Abstract]
[Full Text]
[PDF]
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S.-H. Park and B. Lindholm
DEFINITION OF METABOLIC SYNDROME IN PERITONEAL DIALYSIS
Perit. Dial. Int.,
February 1, 2009;
29(Supplement_2):
S137 - S144.
[Abstract]
[Full Text]
[PDF]
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WRITING GROUP MEMBERS, D. Lloyd-Jones, R. Adams, M. Carnethon, G. De Simone, T. B. Ferguson, K. Flegal, E. Ford, K. Furie, A. Go, et al.
Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Circulation,
January 27, 2009;
119(3):
e21 - e181.
[Full Text]
[PDF]
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I. A Scott
Evaluating cardiovascular risk assessment for asymptomatic people
BMJ,
January 5, 2009;
338(jan05_1):
a2844 - a2844.
[Full Text]
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U. Bulugahapitiya, S. Siyambalapitiya, J. Sithole, D. J Fernando, and I. Idris
The clinical impact of identifying metabolic syndrome in patients with diabetes: a cross-sectional study
Diabetes and Vascular Disease Research,
January 1, 2009;
6(1):
21 - 24.
[Abstract]
[PDF]
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S. Zambon, S. Zanoni, G. Romanato, M. Chiara Corti, M. Noale, L. Sartori, E. Musacchio, G. Baggio, G. Crepaldi, and E. Manzato
Metabolic Syndrome and All-Cause and Cardiovascular Mortality in an Italian Elderly Population: The Progetto Veneto Anziani (Pro.V.A.) Study
Diabetes Care,
January 1, 2009;
32(1):
153 - 159.
[Abstract]
[Full Text]
[PDF]
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C. Weikert, N. Stefan, M. B. Schulze, T. Pischon, K. Berger, H.-G. Joost, H.-U. Haring, H. Boeing, and A. Fritsche
Plasma Fetuin-A Levels and the Risk of Myocardial Infarction and Ischemic Stroke
Circulation,
December 9, 2008;
118(24):
2555 - 2562.
[Abstract]
[Full Text]
[PDF]
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J. Salas-Salvado, J. Fernandez-Ballart, E. Ros, M.-A. Martinez-Gonzalez, M. Fito, R. Estruch, D. Corella, M. Fiol, E. Gomez-Gracia, F. Aros, et al.
Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome Status: One-Year Results of the PREDIMED Randomized Trial
Arch Intern Med,
December 8, 2008;
168(22):
2449 - 2458.
[Abstract]
[Full Text]
[PDF]
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A. Lopez-Suarez, M. Beltran-Robles, J. Elvira-Gonzalez, M. Alwakil, A. Bascunana-Quirell, J. Rosal-Obrador, H. Badani-Gutierrez, M. Oliver-Pece, A. Pons-Raga, J. Ruiz-deCastroviejo, et al.
Does diagnosis of metabolic syndrome predict the likelihood of peripheral arterial disease as defined by a low ankle-brachial index?
European Journal of Cardiovascular Prevention & Rehabilitation,
December 1, 2008;
15(6):
693 - 697.
[Abstract]
[Full Text]
[PDF]
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S. Bo, G. Ciccone, S. Guidi, R. Gambino, M. Durazzo, L. Gentile, M. Cassader, P. Cavallo-Perin, and G. Pagano
Diet or exercise: what is more effective in preventing or reducing metabolic alterations?
Eur. J. Endocrinol.,
December 1, 2008;
159(6):
685 - 691.
[Abstract]
[Full Text]
[PDF]
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M.-A. Cornier, D. Dabelea, T. L. Hernandez, R. C. Lindstrom, A. J. Steig, N. R. Stob, R. E. Van Pelt, H. Wang, and R. H. Eckel
The Metabolic Syndrome
Endocr. Rev.,
December 1, 2008;
29(7):
777 - 822.
[Abstract]
[Full Text]
[PDF]
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F M E Franssen, D E O'Donnell, G H Goossens, E E Blaak, and A M W J Schols
Obesity and the lung: 5 {middle dot} Obesity and COPD
Thorax,
December 1, 2008;
63(12):
1110 - 1117.
[Abstract]
[Full Text]
[PDF]
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Z. T. Bloomgarden
American College of Endocrinology Pre-Diabetes Consensus Conference: Part Two
Diabetes Care,
November 1, 2008;
31(11):
2222 - 2229.
[Full Text]
[PDF]
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H. Sourij and T. C. Wascher
Response to Letter by Bosevski
Stroke,
November 1, 2008;
39(11):
e176 - e176.
[Full Text]
[PDF]
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M. T. Roe, F.-S. Ou, K. P. Alexander, L. K. Newby, J. M. Foody, W. B. Gibler, W. E. Boden, E. M. Ohman, S. C. Smith Jr, and E. D. Peterson
Patterns and prognostic implications of low high-density lipoprotein levels in patients with non-ST-segment elevation acute coronary syndromes
Eur. Heart J.,
October 2, 2008;
29(20):
2480 - 2488.
[Abstract]
[Full Text]
[PDF]
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J. L. Rosenzweig, E. Ferrannini, S. M. Grundy, S. M. Haffner, R. J. Heine, E. S. Horton, and R. Kawamori
Primary Prevention of Cardiovascular Disease and Type 2 Diabetes in Patients at Metabolic Risk: An Endocrine Society Clinical Practice Guideline
J. Clin. Endocrinol. Metab.,
October 1, 2008;
93(10):
3671 - 3689.
[Abstract]
[Full Text]
[PDF]
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F. D'Aiuto, W. Sabbah, G. Netuveli, N. Donos, A. D. Hingorani, J. Deanfield, and G. Tsakos
Association of the Metabolic Syndrome with Severe Periodontitis in a Large U.S. Population-Based Survey
J. Clin. Endocrinol. Metab.,
October 1, 2008;
93(10):
3989 - 3994.
[Abstract]
[Full Text]
[PDF]
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P. G. Surtees, N. W. J. Wainwright, S. M. Boekholdt, R. N. Luben, N. J. Wareham, and K.-T. Khaw
Major Depression, C-Reactive Protein, and Incident Ischemic Heart Disease in Healthy Men and Women
Psychosom Med,
October 1, 2008;
70(8):
850 - 855.
[Abstract]
[Full Text]
[PDF]
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E. S. Ford, C. Li, and N. Sattar
Metabolic Syndrome and Incident Diabetes: Current state of the evidence
Diabetes Care,
September 1, 2008;
31(9):
1898 - 1904.
[Abstract]
[Full Text]
[PDF]
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J. A. Batsis, A. Romero-Corral, M. L. Collazo-Clavell, M. G. Sarr, V. K. Somers, and F. Lopez-Jimenez
Effect of Bariatric Surgery on the Metabolic Syndrome: A Population-Based, Long-term Controlled Study
Mayo Clin. Proc.,
August 1, 2008;
83(8):
897 - 906.
[Abstract]
[Full Text]
[PDF]
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M. J. Blaha, S. Bansal, R. Rouf, S. H. Golden, R. S. Blumenthal, and A. P. DeFilippis
A Practical 'ABCDE' Approach to the Metabolic Syndrome
Mayo Clin. Proc.,
August 1, 2008;
83(8):
932 - 943.
[Abstract]
[Full Text]
[PDF]
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E. WALKER, A. V. HERNANDEZ, and M. W. KATTAN
Meta-analysis: Its strengths and limitations
Cleveland Clinic Journal of Medicine,
June 1, 2008;
75(6):
431 - 439.
[Abstract]
[Full Text]
[PDF]
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J.-P. Despres, I. Lemieux, J. Bergeron, P. Pibarot, P. Mathieu, E. Larose, J. Rodes-Cabau, O. F. Bertrand, and P. Poirier
Abdominal Obesity and the Metabolic Syndrome: Contribution to Global Cardiometabolic Risk
Arterioscler Thromb Vasc Biol,
June 1, 2008;
28(6):
1039 - 1049.
[Abstract]
[Full Text]
[PDF]
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S. M. Grundy
Metabolic Syndrome Pandemic
Arterioscler Thromb Vasc Biol,
April 1, 2008;
28(4):
629 - 636.
[Abstract]
[Full Text]
[PDF]
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J. Sanz, P. R. Moreno, and V. Fuster
The Year in Atherothrombosis
J. Am. Coll. Cardiol.,
March 4, 2008;
51(9):
944 - 955.
[Full Text]
[PDF]
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D. D Morales, F. E. R Punzalan, E. Paz-Pacheco, R. G Sy, and C. A Duante
Metabolic syndrome in the Philippine general population: prevalence and risk for atherosclerotic cardiovascular disease and diabetes mellitus
Diabetes and Vascular Disease Research,
March 1, 2008;
5(1):
36 - 43.
[Abstract]
[PDF]
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G. Hu, J. Lindstrom, P. Jousilahti, M. Peltonen, L. Sjoberg, R. Kaaja, J. Sundvall, and J. Tuomilehto
The Increasing Prevalence of Metabolic Syndrome among Finnish Men and Women over a Decade
J. Clin. Endocrinol. Metab.,
March 1, 2008;
93(3):
832 - 836.
[Abstract]
[Full Text]
[PDF]
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J.-P. Despres and H. B. Brewer
Metabolic syndrome: the dysmetabolic state of dysfunctional adipose tissue and insulin resistance
Eur. Heart J. Suppl.,
March 1, 2008;
10(suppl_B):
B1 - B3.
[Full Text]
[PDF]
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J.-P. Despres, P. Poirier, J. Bergeron, A. Tremblay, I. Lemieux, and N. Almeras
From individual risk factors and the metabolic syndrome to global cardiometabolic risk
Eur. Heart J. Suppl.,
March 1, 2008;
10(suppl_B):
B24 - B33.
[Abstract]
[Full Text]
[PDF]
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A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al.
Highlights of the Year in JACC 2007
J. Am. Coll. Cardiol.,
January 29, 2008;
51(4):
490 - 512.
[Full Text]
[PDF]
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S. D De Ferranti and S. K Osganian
Epidemiology of paediatric metabolic syndrome and type 2 diabetes mellitus
Diabetes and Vascular Disease Research,
December 1, 2007;
4(4):
285 - 296.
[Abstract]
[PDF]
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D. Preiss and N. Sattar
Metabolic syndrome, dysglycaemia and vascular disease: making sense of the evidence
Heart,
December 1, 2007;
93(12):
1493 - 1496.
[Abstract]
[Full Text]
[PDF]
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P. Korantzopoulos, M. Elisaf, and H. J. Milionis
Multifactorial intervention in metabolic syndrome targeting at prevention of chronic kidney disease ready for prime time?
Nephrol. Dial. Transplant.,
October 1, 2007;
22(10):
2768 - 2774.
[Full Text]
[PDF]
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L. Guize, F. Thomas, B. Pannier, K. Bean, B. Jego, and A. Benetos
All-Cause Mortality Associated With Specific Combinations of the Metabolic Syndrome According to Recent Definitions
Diabetes Care,
September 1, 2007;
30(9):
2381 - 2387.
[Abstract]
[Full Text]
[PDF]
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D. Vaidya, M. Szklo, K. Liu, P. J. Schreiner, A. G. Bertoni, and P. Ouyang
Defining the Metabolic Syndrome Construct: Multi-Ethnic Study of Atherosclerosis (MESA) cross-sectional analysis
Diabetes Care,
August 1, 2007;
30(8):
2086 - 2090.
[Abstract]
[Full Text]
[PDF]
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S. Inchiostro, G. P. Fadini, S. V. de Kreutzenberg, N. Citroni, and A. Avogaro
Is the Metabolic Syndrome a Cardiovascular Risk Factor Beyond Its Specific Components?
J. Am. Coll. Cardiol.,
June 26, 2007;
49(25):
2465 - 2465.
[Full Text]
[PDF]
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