National Cholesterol Education Program Versus World Health Organization Metabolic Syndrome in Relation to All-Cause and Cardiovascular Mortality in the San Antonio Heart Study

Abstract

Background-To assess the utility of clinical definitions of the metabolic syndrome (MetS) to identify individuals with increased cardiovascular risk, we examined the relation between the MetS, using both the National Cholesterol Education Program (NCEP) and the World Health Organization definitions, and all-cause and cardiovascular mortality in San Antonio Heart Study participants enrolled between 1984 and 1988. Methods and Results-Among 2815 participants, 25 to 64 years of age at enrollment, 509 met both criteria, 197 met NCEP criteria only, and 199 met WHO criteria only. Over an average of 12.7 years, 229 deaths occurred (117 from cardiovascular disease). Moreover, in the primary prevention population of 2372 participants (ie, those without diabetes or cardiovascular disease at baseline), 132 deaths occurred (50 from cardiovascular disease). In the primary prevention population, the only significant association adjusted for age, gender, and ethnic group was between NCEP-MetS and cardiovascular mortality (hazard ratio [HR], 2.01; 95% CI, 1.13-3.57). In the general population, all-cause mortality HRs were 1.47 (95% CI, 1.13-1.92) for NCEP-MetS and 1.27 (95% CI, 0.97-1.66) for WHO-MetS. Furthermore, for cardiovascular mortality, there was evidence that gender modified the predictive ability of the MetS. For women and men, respectively, HRs for NCEP-MetS were 4.65 (95% CI, 2.35-9.21) and 1.82 (95% CI, 1.14 -2.91), whereas HRs for WHO-MetS were 2.83 (95% CI, 1.55-5.17) and 1.15 (95% CI, 0.72-1.86). Conclusions-In summary, although both definitions were predictive in the general population, the simpler NCEP definition tended to be more predictive in lower-risk subjects.

The metabolic syndrome and cardiovascular risk in the British Regional Heart Study

“…However, in most studies NCEP definition has shown to be similar or more predictive for CVD than the WHO definition [27][28][29] or the IDF definition. 30 Relative risks associated with many of the components of the metabolic syndrome such as hypertension and blood lipids decrease with increasing age, 31 and the prognostic significance of obesity in the elderly is controversial.…”

The metabolic syndrome in elderly individuals is associated with greater muscular, but not elastic arterial stiffness, independent of low-grade inflammation, endothelial dysfunction or insulin resistance—The Hoorn Study

“…5,[18][19][20] This raises the question whether IR, lowgrade inflammation or ED mediate the association between the MetS and arterial stiffness. 7,[21][22][23] Finally, several studies 13,[24][25][26] suggest that the association with CVD in the MetS may be stronger in women than in men, thus raising the question whether the impact of the MetS on arterial stiffness is also stronger in women than in men. 7,11,27 In view of these considerations, the purpose of this study was: (1) to examine in a population-based cohort of elderly individuals the association(s) between the MetS and arterial stiffness of both elastic and muscular arteries; (2) to examine whether any such associations were mediated by low-grade inflammation, IR or ED; and (3) to examine whether any association between the MetS and arterial stiffness is stronger in women than in men.…”

Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction

“…Reaven's 1988 Banting lecture is generally considered a turning point in codifying a unifying principle under the name of MetS or Syndrome X (Reviews: [1-7]. Although there is no universally accepted definition or mechanism, (Table 1) a rough common denominator is the set of five features: obesity (high body weight, BMI and/or waist circumference), high glucose and insulin levels, low HDL, high TAG and high blood pressure.…”