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
Department of Internal Medicine
Mayo Medical Libraries
Division of Hypertension
|| Division of Endocrinology, Nutrition, and Metabolism
¶ Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, Minnesota
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Figure 3 RR and 95% CI for Metabolic Syndrome and Incident Cardiovascular Events and Death, by Specific Outcomes
The diamonds represent the pooled relative risk (RR) and 95% confidence interval (CI) for studies that assessed each outcome. Some studies assessed more than 1 outcome. CHD = coronary heart disease; CV = cardiovascular.
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Figure 4 RR and 95% CI for Metabolic Syndrome and Incident Cardiovascular Events and Death
Studies are listed in chronological order by year that their cohorts were created (except for the last study listed, which includes multiple cohorts). Results are for available analyses of incident cardiovascular disease and death, and may differ from the results of the total study populations. Boxes represent the relative risk (RR), and lines represent the 95% confidence interval (CI) for studies. The diamond represents the pooled RR, and its width represents its 95% CI.
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Figure 5 RR and 95% CI for Metabolic Syndrome and Incident Cardiovascular Events and Death in Studies That Simultaneously Included Metabolic Syndrome and Some of its Components Into Multivariable Models
All studies excluded people with prevalent cardiovascular disease, and 1 study (45) excluded women. "Other" covariates included race (62), study site (in a multicenter study) (62), body mass index (45), C-reactive protein (45), creatinine (60), left ventricular hypertrophy (60), and cigarette smoking (45,60,62). The boxes represent the relative risk (RR) for individual studies and are proportional to their weight in the analysis, and the lines represent their 95% confidence intervals (CIs). The diamond represents the pooled RR, and its width represents its 95% CI. BP = hypertension or elevated systolic or diastolic blood pressure; Glu = fasting hyperglycemia; X = covariate included.
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Figure 6 RR and 95% CI for Incident Coronary Heart Disease Events in Patients Without Prevalent Cardiovascular Disease
Results are for available analyses of incident coronary heart disease events, and may differ from the results of the total study populations. Boxes represent the relative risk (RR) for individual studies and are proportional to their weight in the analysis, and the lines represent their 95% confidence interval (CI). The diamond represents the pooled RR, and its width represents its 95% CI.
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Figure 7 Publication Bias and Its Potential Impact
The blue circles represent individual studies, the blue lines are the funnel plot, and the blue diamond is the relative risk (RR) and 95% confidence interval for the meta-analysis. The red circles represent imputed studies, and the red lines represent the adjusted funnel plot. The red diamond is the RR and 95% confidence interval for the meta-analysis, after adjusting for publication bias. Log (RR) = logarithm of the RR; SE = standard error.
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