The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men
The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men
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DOI：
10.1001/jama.288.21.2709
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发表时间：
2002-12-04
影响因子：
120.7
通讯作者：
Salonen, JT
中科院分区：
文献类型：
--
作者：
Lakka, HM;Laaksonen, DE;Salonen, JT
背景代谢综合征是葡萄糖和胰岛素代谢紊乱、超重和腹部脂肪分布、轻度血脂异常和高血压的并发症，与2型糖尿病和心血管疾病（CVD）的后续发展相关。尽管它的高患病率，很少有人知道的前瞻性关联的代谢综合征与心血管和总morts.Objective评估协会的代谢综合征与心血管和总morts.Design，设置和参与者使用最近提出的定义和因素analysis. The库奥皮奥缺血性心脏病危险因素研究，一个人口为基础，对1209名芬兰男性进行的前瞻性队列研究，基线年龄为42 - 60岁（1984-1989年），最初无CVD、癌症或糖尿病。随访持续到1998年12月。主要结果测量冠心病（CHID）、心血管疾病和任何原因导致的死亡，采用基于国家胆固醇教育计划（NCEP）和世界卫生组织（WHO）的4种定义，在有代谢综合征的男性与无代谢综合征的男性中进行比较。在大约11.4年的随访期间，有109例死亡，其中46例和27例死亡。心血管疾病和冠心病。男性代谢综合征定义为。NCEP为2.9（95%置信区间[CI]，1.2-7.2）至4.2（95% CI，1.6-10.8）倍，根据WHO定义，校正常规心血管危险因素后，死于CHD的可能性为2.9（95% CI，1.2-6.8）至3.3（95% CI，1.4-7.7）倍。WHO定义的代谢综合征与CVD死亡率高2.6（95%Cl，1.4-5.1）至3.0（95%Cl，1.5-5.7）倍和全因死亡率高1.9（95%Cl，1.2-3.0）至2.1（95%Cl，1.3-3.3）倍相关。NCEP定义预测CVD和全因死亡率的一致性较低。使用13个与代谢或心血管风险相关的变量进行因子分析，产生了一个代谢综合征因子，解释了总方差的18%。在最高四分之一的代谢因子负荷的男性为3.6（95% CI，1.7-7.9），3.2（95% Cl，1.7-5.8）和2.3（95%CI，1.5-3.4）倍，更有可能死于冠心病，心血管疾病，和任何原因，分别。结论心血管疾病和全因死亡率增加的男性代谢综合征，即使在没有心血管疾病和糖尿病的情况下。代谢综合征的早期识别、治疗和预防对面临超重和久坐生活方式流行的卫生保健专业人员提出了重大挑战。
Context The metabolic syndrome, a concurrence of disturbed glucose and insulin metabolism, overweight and abdominal fat distribution, mild dyslipidemia, and hypertension, is associated with subsequent development of type 2 diabetes mellitus and cardiovascular disease (CVD). Despite its high prevalence, little is known of the prospective association of the metabolic syndrome with cardiovascular and overall mortality.Objective To assess the association of the metabolic syndrome with cardiovascular and overall mortality using recently proposed definitions and factor analysis.Design, Setting, and Participants The Kuopio Ischaemic Heart Disease Risk Factor Study, a population-based, prospective cohort study of 1209 Finnish men aged 42 to 60 years at baseline (1984-1989) who were initially without CVD, cancer, or diabetes. Follow-up continued through December 1998.Main Outcome Measures Death due to coronary heart disease (CHID), CVD, and any cause among men with vs without the metabolic syndrome, using 4 definitions based on the National Cholesterol Education Program (NCEP) and the World Health Organization (WHO).Results The prevalence of the metabolic syndrome ranged from 8.8% to 14.3%, depending on the definition. There were 109 deaths during the approximately 11.4-year follow-up, of which 46 and 27 were due.,to CVD and CHD, respectively. Men with the metabolic syndrome as defined by the. NCEP were 2.9 (95% confidence interval [Cl], 1.2-7.2) to 4.2 (95% Cl, 1.6-10.8) times more likely and , as defined by the WHO, 2.9 (95% Cl, 1.2-6.8) to 3.3 (95% Cl, 1.4-7.7) times more likely to die of CHD after adjustment for conventional cardiovascular risk factors. The metabolic syndrome as defined by the WHO was associated with 2.6 (95 % Cl, 1.4-5.1) to 3.0 (95% Cl, 1.5-5.7) times higher CVD mortality and 1.9 (95% Cl, 1.2-3.0) to 2.1 (95% Cl, 1.3-3.3) times higher all-cause mortality. The NCEP definition less consistently predicted CVD and all-cause mortality. Factor analysis using 13 variables associated with metabolic or cardiovascular risk yielded a metabolic syndrome factor that explained 18% of total variance. Men with loadings on the metabolic factor in the highest quarter were 3.6 (95% Cl, 1.7-7.9),3.2 (95% Cl, 1.7-5.8), and 2.3 (95% Cl, 1.5-3.4) times more likely to die of CHD, CVD, and any cause, respectively.Conclusions Cardiovascular disease and all-cause mortality are increased in men with the metabolic syndrome, even in the absence of baseline CVD and diabetes. Early identification, treatment, and prevention of the metabolic syndrome present a major challenge for health care professionals facing an epidemic of overweight and sedentary lifestyle.