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 Reaven’s 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
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[Abstract]
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S.-H. Park and B. Lindholm
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[Abstract]
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I. A Scott
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U. Bulugahapitiya, S. Siyambalapitiya, J. Sithole, D. J Fernando, and I. Idris
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[Abstract]
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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
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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
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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.
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S. Bo, G. Ciccone, S. Guidi, R. Gambino, M. Durazzo, L. Gentile, M. Cassader, P. Cavallo-Perin, and G. Pagano
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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
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F M E Franssen, D E O'Donnell, G H Goossens, E E Blaak, and A M W J Schols
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Z. T. Bloomgarden
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H. Sourij and T. C. Wascher
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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
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F. D'Aiuto, W. Sabbah, G. Netuveli, N. Donos, A. D. Hingorani, J. Deanfield, and G. Tsakos
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P. G. Surtees, N. W. J. Wainwright, S. M. Boekholdt, R. N. Luben, N. J. Wareham, and K.-T. Khaw
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Psychosom Med,
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[Abstract]
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E. S. Ford, C. Li, and N. Sattar
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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
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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
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E. WALKER, A. V. HERNANDEZ, and M. W. KATTAN
Meta-analysis: Its strengths and limitations
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[Abstract]
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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,
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28(6):
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[Abstract]
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S. M. Grundy
Metabolic Syndrome Pandemic
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J. Sanz, P. R. Moreno, and V. Fuster
The Year in Atherothrombosis
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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
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[Abstract]
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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
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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.,
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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
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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.
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S. D De Ferranti and S. K Osganian
Epidemiology of paediatric metabolic syndrome and type 2 diabetes mellitus
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285 - 296.
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D. Preiss and N. Sattar
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Heart,
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P. Korantzopoulos, M. Elisaf, and H. J. Milionis
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L. Guize, F. Thomas, B. Pannier, K. Bean, B. Jego, and A. Benetos
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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
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S. Inchiostro, G. P. Fadini, S. V. de Kreutzenberg, N. Citroni, and A. Avogaro
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