Metabolic syndrome and mortality in older adults - The cardiovascular health study

被引:124
作者
Mozaffarian, Dariush [1 ,2 ,3 ,4 ]
Kamineni, Aruna [5 ]
Prineas, Ronald J. [8 ]
Siscovick, David S. [6 ,7 ]
机构
[1] Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA
[2] Harvard Univ, Sch Med, Boston, MA 02115 USA
[3] Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA
[4] Harvard Univ, Sch Publ Hlth, Dept Nutr, Boston, MA 02115 USA
[5] Univ Washington, Dept Biostat, Seattle, WA 98195 USA
[6] Univ Washington, Cardiovasc Hlth Res Unit, Dept Med, Seattle, WA 98195 USA
[7] Univ Washington, Cardiovasc Hlth Res Unit, Dept Epidemiol, Seattle, WA 98195 USA
[8] Wake Forest Univ, Div Publ Hlth Sci, Sch Med, Winston Salem, NC 27109 USA
关键词
D O I
10.1001/archinte.168.9.969
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The utility of metabolic syndrome (MetS) for predicting mortality among older adults, the highest-risk population, is not well established. In addition, few studies have compared the predictive utility of MetS to that of its individual risk factors. Methods: We evaluated relationships of MetS (as defined by the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [Adult Treatment Panel III (ATPIII)], International Diabetes Foundation [IDF], and World Health Organization [WHO]) and individual MetS criteria with mortality between 1989 and 2004 among 4258 US adults 65 years or older and free of prevalent cardiovascular disease (CVD) in the Cardiovascular Health Study, a multicenter, population-based, prospective cohort. Total, CVD, and non-CVD mortality were evaluated. Cox proportional hazards models were used to estimate the mortality hazard ratio (relative risk [RR]) predicted by MetS. Results: At baseline (mean age, 73 years), 31% of men and 38% of women had MetS (ATPIII). During 15 years of follow-up, 2116 deaths occurred. After multivariable adjustment, compared with persons without MetS, those with MetS had a 22% higher mortality (RR, 1.22; 95% confidence interval [CI], 1.11-1.34). Higher risk with MetS was confined to persons having elevated fasting glucose level (EFG) (defined as >= 110 mg/dL [>= 6.1 mmol/L] or treated diabetes mellitus) (RR, 1.41; 95% CI, 1.27-1,57)or hypertension (RR, 1.26; 95% CI, 1.15-1.39) as one of the criteria; persons having MetS without EFG (RR, 0.97; 95% CI, 0.85-1.11) or MetS without hypertension (RR, 0.92; 95% CI, 0.71-1.19) did not have higher risk. Evaluating MetS criteria individually, we found that only hypertension and EFG predicted higher mortality; persons having both hypertension and EFG had 82% higher mortality (RR, 1.82; 95% CI, 1.58-109). Substantially higher proportions of deaths were attributable to EFG and hypertension (population attributable risk fraction [PAR%], 22.2%) than to MetS (PAR%, 6.3%). Results were similar when we used WHO or IDF criteria, when we evaluated different cut points of each individual criterion, and when we evaluated CVD mortality. Conclusion: These findings suggest limited utility of MetS for predicting total or CVD mortality in older adults compared with assessment of fasting glucose and blood pressure alone.
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收藏
页码:969 / 978
页数:10
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