Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults
Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults
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DOI：
10.1161/01.cir.0000140677.20606.0e
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发表时间：
2004-09-01
期刊：
影响因子：
37.8
通讯作者：
Williams, GR
中科院分区：
文献类型：
--
作者：
Malik, S;Wong, ND;Williams, GR
背景-糖尿病和既往心血管疾病患者中，由冠心病(CHD)、心血管疾病(CVD)和各种原因导致的死亡率很高；然而，与代谢综合征(METS)患者相比，这些风险尚不清楚。方法和结果：在一项前瞻性队列研究中，来自第二次全国健康和营养检查调查的6255名年龄在30到75岁(54%为女性)的受试者(代表美国的百万成年人)被跟踪调查了平均+/-SD13.3+/-3.8年。METS是由修改后的国家胆固醇教育计划标准定义的。经样本加权多变量COX比例风险回归分析，与既无METS又无CVD史的患者相比，METS患者的年龄、性别和危险因素调整后的冠心病死亡率风险比(HR)分别为2.02(95%CI，1.42~2.89)和4.19(95%CI，3.04~5.79)。心血管病死率分别为1.82(95%CI，1.40~2.37)和3.14(95%CI，2.49~3.96)，总死亡率分别为1.40(95%CI，1.19~1.66)和1.87(95%CI，1.60~2.17)。在患有甲状旁腺素但没有糖尿病的人中，冠心病和心血管疾病死亡的风险仍然很高。糖尿病可以预测所有的死亡终点。即使只有1到2个甲硫氨酸转移酶危险因素，也会增加冠心病和心血管疾病的死亡风险。此外，METS对CHD、CVD和总死亡率的预测比其单独成分更强。结论：在患有METS的美国成年人中，CHD、CVD和总死亡率显著高于未患METS的成年人。
Background-Mortality resulting from coronary heart disease (CHD), cardiovascular disease (CVD), and all causes in persons with diabetes and pre-existing CVD is high; however, these risks compared with those with metabolic syndrome (MetS) are unclear. We examined the impact of MetS on CHD, CVD, and overall mortality among US adults.Methods and Results-In a prospective cohort study, 6255 subjects 30 to 75 years of age (54% female) ( representative of 64 million adults in the United States) from the Second National Health and Nutrition Examination Survey were followed for a mean +/- SD of 13.3 +/- 3.8 years. MetS was defined by modified National Cholesterol Education Program criteria. From sample-weighted multivariable Cox proportional-hazards regression, compared with those with neither MetS nor prior CVD, age-, gender-, and risk factor-adjusted hazard ratios (HRs) for CHD mortality were 2.02 (95% CI, 1.42 to 2.89) for those with MetS and 4.19 (95% CI, 3.04 to 5.79) for those with pre-existing CVD. For CVD mortality, HRs were 1.82 (95% CI, 1.40 to 2.37) and 3.14 (95% CI, 2.49 to 3.96), respectively; for overall mortality, HRs were 1.40 (95% CI, 1.19 to 1.66) and 1.87 (95% CI, 1.60 to 2.17), respectively. In persons with MetS but without diabetes, risks of CHD and CVD mortality remained elevated. Diabetes predicted all mortality end points. Those with even 1 to 2 MetS risk factors were at increased risk for mortality from CHD and CVD. Moreover, MetS more strongly predicts CHD, CVD, and total mortality than its individual components.Conclusions-CHD, CVD, and total mortality are significantly higher in US adults with than in those without MetS.