Metabolic syndrome and its components as predictors of all-cause mortality and coronary heart disease in type 2 diabetic patients



      There is no consistent evidence regarding the prognostic value of metabolic syndrome (MS) in predicting all-cause mortality and coronary heart disease (CHD) risk among type 2 diabetic patients. We sought to investigate whether individual or various combinations of MS components have a different predictive value than the presence of MS in this setting.


      Six hundred type 2 diabetic patients (mean age 60.4 ± 9 years, 54% males) without known CHD were prospectively followed-up for a mean period of 10.06 years. The presence of MS was examined using the National Cholesterol Education Program (NCEP) definition. Statistical analyses were performed using Kaplan–Meier estimator and Cox proportional Hazard models.


      MS was present in 62.4% of the patients while 142 died during follow-up. Significant predictors for all-cause mortality were the presence of MS (HR 1.75), sex (HR 1.69), age (HR 1.09), and diabetes duration (HR 1.02). Regarding CHD incidents, HDL (HR 0.98), systolic blood pressure (HR 1.01), sex (HR 2.05), and total cholesterol (HR 1.005) were significant predictors while the presence of MS was not. Subjects fulfilling the triad consisting of diabetes, hypertension, and low HDL or the combination of diabetes, hypertension, low HDL, and high triglyceride levels had the highest probability for developing CHD events (HR 1.79, 1.73, respectively).


      The presence of MS in type 2 diabetic patients without known CHD reduces the 10-year survival while specific combinations of its components have different impact on CHD risk.


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        • Haffner S.M.
        Risk constellations in patients with the metabolic syndrome: epidemiology, diagnosis, and treatment patterns.
        Am J Med. 2006; 119: S3-S9
        • Grundy S.M.
        Metabolic syndrome: connecting and reconciling cardiovascular and diabetes world.
        J Am Coll Cardiol. 2006; 47: 1093-1100
      1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Programme (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486–97.

        • Isomaa B.
        • Almgren P.
        • Tuomi T.
        • et al.
        Cardiovascular morbidity and mortality associated with the metabolic syndrome.
        Diabetes Care. 2001; 24: 683-689
        • Lakka H.M.
        • Laaksonen D.E.
        • Lakka T.A.
        • et al.
        The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men.
        JAMA. 2002; 288: 2709-2716
        • Sattar N.
        • Gaw A.
        • Scherbakova O.
        • et al.
        Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study.
        Circulation. 2003; 108: 414-419
        • Hunt K.J.
        • Resendez R.G.
        • Williams K.
        • et al.
        National Cholesterol Education Program versus World Health Organization metabolic syndrome in relation to all-cause and cardiovascular mortality in the San Antonio Heart Study.
        Circulation. 2004; 110: 1251-1257
        • Alexander C.M.
        • Landsman P.B.
        • Teutsch S.M.
        • Haffner S.M.
        NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III, participants age 50 years and older.
        Diabetes. 2003; 52: 1210-1214
        • Bruno G.
        • Merletti F.
        • Biggeri A.
        • et al.
        Metabolic syndrome as a predictor of all-cause and cardiovascular mortality in type 2 diabetes: the Casale Monferrato Study.
        Diabetes Care. 2004; 27: 2689-2694
        • Resnick H.E.
        • Jones K.
        • Ruotolo G.
        • et al.
        Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease in non diabetic American Indians: the Strong Heart Study.
        Diabetes Care. 2003; 26: 861-867
        • McNeill A.
        • Rosamond W.R.
        • Girman C.J.
        • et al.
        The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study.
        Diabetes Care. 2005; 28: 385-390
        • Friedwald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge.
        Clin Chem. 1972; 18: 499-502
        • Hu G.
        • DECODE Study Group
        Gender difference in all-cause and cardiovascular mortality related to hyperglycaemia and newly-diagnosed diabetes.
        Diabetologia. 2003; 46: 608-617
        • Brun E.
        • Nelson R.G.
        • Bennett P.H.
        • et al.
        Diabetes duration and cause-specific mortality in the Verona Diabetes Study.
        Diabetes Care. 2000; 23: 1119-1123
        • Fox C.S.
        • Sullivan L.
        • D’Agostino R.B.
        • Wilson P.W.F.
        The significant effect of diabetes duration on coronary heart disease mortality. The Framingham Heart Study.
        Diabetes Care. 2004; 27: 704-708
        • Tuomilehto J.
        • Balkau B.
        • Borch-Johnsen K.
        • Pyorala K.
        Prevalence of the metabolic syndrome and its relation to all cause and cardiovascular mortality in non diabetic European men and women.
        Arch Intern Med. 2004; 164: 1066-1076
        • Ford E.S.
        Risks for all cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome.
        Diabetes Care. 2005; 28: 1769-1778
        • Ko G.T.
        • So W.Y.
        • Chan N.N.
        • et al.
        Prediction of cardiovascular and total mortality in Chinese type 2 diabetic patients by the WHO definition for the metabolic syndrome.
        Diabetes Obes Metab. 2006; 8: 94-104
        • Sundstrom J.
        • Riserus U.
        • Byberg L.
        • et al.
        Clinical value of the metabolic syndrome for long term prediction of total and cardiovascular mortality: prospective, population based cohort study.
        BMJ. 2006; 332: 878-882
        • Malik S.
        • Wong N.D.
        • Franklin S.S.
        • et al.
        Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease and on all causes in United States adults.
        Circulation. 2004; 110: 1245-1250
        • Ford E.S.
        • Giles W.H.
        A comparison of the prevalence of the metabolic syndrome using two proposed definitions.
        Diabetes Care. 2003; 26: 575-581
        • Turner R.
        • Millns H.
        • Neil H.
        • et al.
        Risk factors for coronary artery disease in non insulin-dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS 23).
        BMJ. 1998; 316: 823-828
        • Bonora E.
        • Formentini G.
        • Calcatera F.
        • et al.
        HOMA-estimated insulin resistance is an independent predictor of cardiovascular disease in type 2 diabetic subjects: prospective data from the Verona Diabetes Complications Study.
        Diabetes Care. 2002; 25: 1135-1141
        • Adler A.I.
        • Levy J.C.
        • Matthews D.R.
        • et al.
        Insulin sensitivity at diagnosis of type 2 diabetes is not associated with subsequent carduiovascular disease (UKPDS 67).
        Diabetes Med. 2005; 22: 306-311
        • Guzder R.N.
        • Gatling W.
        • Mulle M.A.
        • Byrne C.D.
        Impact of metabolic syndrome criteria on cardiovascular disease risk in people with newly diagnosed type 2 diabetes.
        Diabetologia. 2006; 49: 49-55
        • Klein B.E.K.
        • Klein R.
        • Lee K.E.
        Components of the metabolic syndrome and risk of cardiovascular disease and diabetes in Beaver Dam.
        Diabetes Care. 2002; 25: 1790-1794
        • Golden S.H.
        • Folsom A.R.
        • Coresh J.
        • et al.
        Risk factor groupings related to insulin resistance and their synergistic effects on subclinical atherosclerosis. The atherosclerosis risk in communities study.
        Diabetes. 2002; 51: 3069-3076
        • Ford E.S.
        • Giles W.H.
        • Dietz W.H.
        Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey.
        JAMA. 2002; 287: 356-359
        • Panagiotakos D.
        • Pitsavos C.
        • Chrysohoou C.
        • et al.
        Impact of lifestyle habits on the prevalence of the metabolic syndrome among Greek adults from the ATTICA Study.
        Am Heart J. 2004; 147: 106-112
        • Linnemann B.
        • Voigt W.
        • Nobel W.
        • Janka H.U.
        C-reactive protein is a strong independent predictor of death in type 2 diabetes: association with multiple facets of the metabolic syndrome.
        Exp Clin Endocrinol Diabetes. 2006; 114: 127-134