Total and Cardiovascular Disease Mortality Predicted by Metabolic Syndrome is Inferior Relative to its Components

Häring, R.; Wallaschofski, Henri; Nauck, Matthias; Felix, Stephan B.; Schmidt, Carsten Oliver; Dörr, Marcus; Sauer, Sybille; Wilmking, G.; Völzke, Henry

doi:10.1055/s-0030-1261876

Cited by 28 publications

(24 citation statements)

References 29 publications

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“…27 28 32 33 Some argue that in defining MS, we lose rather than gain predictive power for CVD and mortality if MS does not confer any risk beyond that of its individual components, because in defining MS in a dichotomous fashion, requiring the presence of three or more risk factors, we lose predictive information from some risk factors entirely and from others in part. 5 7 Some individual reports, [8][9][10] and meta-analyses 2 34 suggest that the value of MS beyond that of its individual components or traditional risk factors as a predictor of mortality and CVD is modest at best, in contrast to other reports. [12][13][14][15][16][17] However, as Ford 2 suggests, a gradient of risk of adverse outcomes may exist within MS due to other factors not included in the definition.…”

Section: Discussionmentioning

confidence: 99%

“…5 6 Detractors from MS have suggested that its relevance in terms of CVD risk is no greater than the contribution of the individual components. [7][8][9][10][11] Others have suggested that MS contributes significantly to CVD risk after correcting for risk associated with MS components in isolation, and/ or traditional CVD risk factors not included in the definitions of MS (eg, smoking). [12][13][14][15][16][17] Differences in the characteristics of populations studied may account for some of the observed disparity in studies of MS and CVD, and-in particular-many, 8 13 18-23 but not all, 17 24 25 studies have suggested MS may have little or no association with CVD in elderly populations.…”

Section: Introductionmentioning

confidence: 99%

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Influence of age on the prevalence and components of the metabolic syndrome and the association with cardiovascular disease

Devers

Campbell

Simmons

2016

BMJ Open Diab Res Care

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ObjectiveThe significance of the metabolic syndrome (MS) is debated. We investigated whether MS component (by ATPIII and IDF definitions) clustering and any association between MS and prevalent cardiovascular disease (CVD) varied with age.Research design and methodsIn all, 1429 adults (≥25 years) from randomly selected households in rural Victoria, Australia, were assessed for components of MS and prevalent CVD. The expected prevalence of MS was calculated following a simple probabilistic model using the prevalence of each MS component.ResultsThe observed prevalence of MS was greater than expected: 27.0% vs 21.2% (ATPIII) and 36.0% vs 30.1% (IDF; p<0.0001), based on the prevalence of individual components. There was significant clustering of 4 and 5 MS components in participants <65 years (p<0.0001). CVD was more prevalent in MS participants, 13.5% (IDF), 14.5% (ATPIII) versus 5.3% (no MS) p<0.0001. The OR for CVD in MS participants was greatest in those <45 years OR (95% CI): IDF 17.5 (1.8 to 172); ATPIII 24.3(2.4 to 241), p<0.001 for both, and was not significant in those >65 years. The prevalence of MS (ATPIII) with normal waist circumference (WC) was less than expected (4.8% vs 7.9%, p<0.002). Low levels of high-density lipoprotein and high triglyceride were less common in older MS participants.ConclusionsATPIII MS is rare among those with a normal WC. MS components cluster most markedly among those aged <65 years, who also experience substantially greater rates of CVD. Younger patients with MS may warrant more aggressive CVD preventative treatment than suggested by the summation of their individual risk factors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of age on the prevalence and components of the metabolic syndrome and the association with cardiovascular disease

Devers

Campbell

Simmons

2016

BMJ Open Diab Res Care

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“…[1][2][3][4][5][6][7] This is true not only in the general population but also in patients with the syndrome and type 2 diabetes mellitus, where it accounts for up to one-third of CVD in men and approximately half of new cases. 8,9 Yet, this association has been seriously questioned, [10][11][12] so that it appears that this issue is far from being settled clinically and semantically. [13][14][15] This discrepancy of opinions is probably dictated by the complex pathophysiology of the syndrome itself.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Metabolic Syndrome and Its Relationship with Clinically Prevalent Cardiovascular Disease in the Veneto Region, Northeastern Italy

Novelletto

Guzzinati²,

Avogaro³

2012

Metabolic Syndrome and Related Disorders

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“…However, when we used genetic instruments in subsequent IV analyses to represent lifetime serum testosterone concentrations free of residual confounding or reverse causation, none of these previous associations were proved to be causal. The metabolic syndrome consists of a cluster of cardiometabolic risk factors, including visceral obesity, glucose intolerance, dyslipidaemia and hypertension; which strongly predict subsequent CVD (Sattar et al, 2003) and mortality (Haring et al, 2010c). However, although previous prospective studies showed that low testosterone concentration precede the development of metabolic syndrome (Haring et al, 2009b;Kupelian et al, 2006), reverse causality remains a possibility (Laaksonen et al, 2005), as it remains still unclear whether low testosterone concentrations contributes to or are a very early consequence of mechanisms finally leading to overt metabolic syndrome.…”

Section: Discussionmentioning

confidence: 99%

Mendelian randomization suggests non‐causal associations of testosterone with cardiometabolic risk factors and mortality

et al. 2012

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SUMMARYProspective studies showed that low serum testosterone concentrations are associated with various cardiometabolic risk factors and mortality. However, the causal nature of these associations is controversial. We studied 1 882 men aged 20-79 years with serum testosterone concentrations and genotyping data from the longitudinal population-based Study of Health in Pomerania. Testosterone concentrations were cross-sectionally associated with cardiometabolic risk factors, including anthropometric, lipid, blood pressure and glycaemic parameters; and prospectively with all-cause mortality (277 deaths, 14.7%) during the 10-year follow-up. To overcome problems of residual confounding, reverse causation, or regression dilution bias in the investigated testosterone-outcome associations, we used two-stage least square regression models with previously identified polymorphisms at the SHBG gene (rs12150660) and X chromosome (rs5934505) as multiple genetic instruments in an instrumental variable (IV) approach, also known as Mendelian randomization. In standard regression analyses, testosterone was robustly associated with a wide range of cardiometabolic risk factors. In subsequent IV analyses, no such significant associations were observed. Similarly, prospective analyses showed a consistent association of low testosterone concentrations with increased all-cause mortality risk, which was not apparent in subsequent IV analyses. The present Mendelian randomization analyses did not detect any evidence for causal associations of testosterone concentrations with cardiometabolic risk factors and mortality, suggesting that previously reported associations might largely result from residual confounding or reverse causation. Although testosterone assessment might improve risk prediction, implementation of testosterone replacement therapy requires further evidence of a direct effect on cardiometabolic outcomes from double-blinded randomized controlled trials and large-scale Mendelian randomization meta-analyses.

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Total and Cardiovascular Disease Mortality Predicted by Metabolic Syndrome is Inferior Relative to its Components

Abstract: There was no added predictive value of MetS beyond its individual components with respect to mortality risk. Attention should be redirected to the individual components, particularly visceral obesity and high glucose, to treat each abnormality appropriately.

Cited by 28 publications

References 29 publications

Influence of age on the prevalence and components of the metabolic syndrome and the association with cardiovascular disease

Influence of age on the prevalence and components of the metabolic syndrome and the association with cardiovascular disease

Prevalence of Metabolic Syndrome and Its Relationship with Clinically Prevalent Cardiovascular Disease in the Veneto Region, Northeastern Italy

Mendelian randomization suggests non‐causal associations of testosterone with cardiometabolic risk factors and mortality

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