The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-aged Men

Lakka, Hanna‐Maaria; Laaksonen, David E.; Lakka, Timo A.; Niskanen, Leo; Kumpusalo, Esko; Tuomilehto, Jaakko; Salonen, Jukka T.

doi:10.1001/jama.288.21.2709

Cited by 4,261 publications

(2,845 citation statements)

References 43 publications

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“…It affects approximately 1 in 3 Americans, women more so than men 1. Metabolic syndrome contributes considerably to cardiovascular mortality,2, 3, 4, 5, 6 particularly among women 7. Whether it adds incremental value to the prognostication of cardiovascular mortality beyond the constellation of factors comprising it is debated 8…”

Section: Introductionmentioning

confidence: 99%

The Metabolic Syndrome and Risk of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study

Hess

Al‐Khalidi

Friedman

et al. 2017

JAHA

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BackgroundPrior studies have demonstrated a link between the metabolic syndrome and increased risk of cardiovascular mortality. Whether the metabolic syndrome is associated with sudden cardiac death is uncertain.Methods and ResultsWe characterized the relationship between sudden cardiac death and metabolic syndrome status among participants of the ARIC (Atherosclerosis Risk in Communities) Study (1987–2012) free of prevalent coronary heart disease or heart failure. Among 13 168 participants, 357 (2.7%) sudden cardiac deaths occurred during a median follow‐up of 23.6 years. Participants with the metabolic syndrome (n=4444) had a higher cumulative incidence of sudden cardiac death than those without it (n=8724) (4.1% versus 2.3%, P<0.001). After adjustment for participant demographics and clinical factors other than components of the metabolic syndrome, the metabolic syndrome was independently associated with sudden cardiac death (hazard ratio, 1.70, 95% confidence interval, 1.37–2.12, P<0.001). This relationship was not modified by sex (interaction P=0.10) or race (interaction P=0.62) and was mediated by the metabolic syndrome criteria components. The risk of sudden cardiac death varied according to the number of metabolic syndrome components (hazard ratio 1.31 per additional component of the metabolic syndrome, 95% confidence interval, 1.19–1.44, P<0.001). Of the 5 components, elevated blood pressure, impaired fasting glucose, and low high‐density lipoprotein were independently associated with sudden cardiac death.ConclusionsWe observed that the metabolic syndrome was associated with a significantly increased risk of sudden cardiac death irrespective of sex or race. The risk of sudden cardiac death was proportional to the number of metabolic syndrome components.

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Section: Introductionmentioning

confidence: 99%

The Metabolic Syndrome and Risk of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study

Hess

Al‐Khalidi

Friedman

et al. 2017

JAHA

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“…The effect of the metabolic syndrome (MetS) in subjects without established cardiovascular disease is well established, including increased noncardiovascular morbidity and general mortality 1, 2, 3, 4, 5, 6, 7. Moreover, each of the independent components of the MetS has also been associated with an increased risk of cardiovascular events and mortality, with a variation in the magnitude of these relationships among the different individual components 4, 8, 9, 10, 11…”

mentioning

confidence: 99%

“…Moreover, each of the independent components of the MetS has also been associated with an increased risk of cardiovascular events and mortality, with a variation in the magnitude of these relationships among the different individual components 4, 8, 9, 10, 11…”

mentioning

confidence: 99%

Impaired Fasting Glucose Is the Major Determinant of the 20‐Year Mortality Risk Associated With Metabolic Syndrome in Nondiabetic Patients With Stable Coronary Artery Disease

Younis

Goldkorn

Goldenberg

et al. 2017

JAHA

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BackgroundWe wanted to explore the association of metabolic syndrome (MetS) versus its individual components with 20‐year all‐cause mortality among patients with stable coronary artery disease.Methods and ResultsThe cohort comprised 12 403 nondiabetic patients with stable coronary artery disease who were enrolled in the Bezafibrate Infarction Prevention Registry between February 1990 and October 1992 and followed up through December 2014. The study cohort was divided into 4 groups: patients without MetS or impaired fasting glucose (IFG), patients with IFG but without MetS, patients with MetS but without IFG, and patients with both MetS and IFG. Kaplan‐Meier survival analysis showed that at 20 years of follow‐up, the rates of all‐cause mortality were the highest among patients with both MetS and IFG (66%). Patients with IFG without MetS experienced a significantly higher mortality rate compared with those with MetS without IFG (61% versus 56%; log‐rank P<0.001). Multivariable Cox proportional hazard analysis showed that the final Cox model demonstrated that the additive effect of MetS (hazard ratio, 1.13; 95% confidence interval, 1.1–1.16; P=0.02) and IFG (hazard ratio, 1.54; 95% confidence interval, 1.46–1.62; P<0.001) on 20 years mortality was nonsignificant (hazard ratio, 1.01; 95% confidence interval, 0.93–1.11; P=0.69). IFG was associated with the most pronounced increase in mortality risk among the individual components (hazard ratio, 1.22; 95% confidence interval, 1.14–1.3; P<0.001).ConclusionsOur findings suggest that IFG alone is a major independent predictor of long‐term mortality among patients with stable coronary artery disease versus other components of the MetS.

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“…In one large study, the overall hazard ratios for CVD mortality in those with metabolic syndrome were 2.26 and 2.78 in men and women, respectively [4]. This increased risk of cardiovascular and coronary heart disease in patients with the metabolic syndrome has been validated in at least 2 other large-scale trials [5].…”

Section: Obesity and Atherosclerotic Coronary Artery Diseasementioning

confidence: 95%

Cardiovascular consequences of obesity and targets for treatment

Mittendorfer

Peterson

2008

Drug Discovery Today: Therapeutic Strategies

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Obesity is a risk factor for cardiovascular disease, including coronary artery disease and heart failure, but the mechanisms by which it may cause them are not completely clear. Currently, therapies aimed at obesity-related cardiovascular disease include weight loss strategies and reduction of the other risk factors that are associated with obesity and cardiovascular disease. Other pathways with for potential drug development for obesity-related CVD are also discussed. Keywordsobesity; myocardium; metabolism; systolic function; diastolic function; coronary artery disease Cardiovascular disease (CVD) is still the leading cause of death in developed countries, despite a recent decline in coronary artery disease-related deaths. In the United States approximately 35% of all deaths are due to CVD [1]. Obesity (defined as a body mass index [BMI] of ≥ 30 kg/m 2 ) is a risk factor for CVD, especially coronary heart disease and heart failure. It is estimated that the relative risk of coronary heart disease in obesity is approximately 1.5 even after adjusting for all other traditional coronary heart disease risk factors that often co-migrate with obesity (e.g. hyperlipidemia, hypertension) [2]. Obesity also is associated with an increased risk of heart failure, with ~11 -14% of all heart failure thought to be attributable to obesity [3]. Given that excess body weight now affects more than 300 million persons worldwide, prevention and treatment of obesity should be considered one of the cornerstones for the prevention of CVD (http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/). This review will focus on the impact of obesity on CVD, particularly atherosclerotic coronary artery disease and heart failure and treatment of obesity-related heart disease.

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The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-aged Men

Cited by 4,261 publications

References 43 publications

The Metabolic Syndrome and Risk of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study

The Metabolic Syndrome and Risk of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study

Impaired Fasting Glucose Is the Major Determinant of the 20‐Year Mortality Risk Associated With Metabolic Syndrome in Nondiabetic Patients With Stable Coronary Artery Disease

Cardiovascular consequences of obesity and targets for treatment

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