The Metabolic Syndrome and Cardiovascular Risk: A Systematic Review and Meta-Analysis

Jewish General Hospital/McGill University, Montreal, Quebec, Canada.
Journal of the American College of Cardiology (Impact Factor: 15.34). 09/2010; 56(14):1113-32. DOI: 10.1016/j.jacc.2010.05.034
Source: PubMed

ABSTRACT We sought to conduct a systematic review and meta-analysis of the cardiovascular risk associated with the metabolic syndrome as defined by the 2001 National Cholesterol Education Program (NCEP) and 2004 revised National Cholesterol Education Program (rNCEP) definitions.
Numerous studies have investigated the cardiovascular risk associated with the NCEP and rNCEP definitions of the metabolic syndrome. There is debate regarding the prognostic significance of the metabolic syndrome for cardiovascular outcomes.
We searched the Cochrane Library, EMBASE, and Medline databases through June 2009 for prospective observational studies investigating the cardiovascular effects of the metabolic syndrome. Two reviewers extracted data, which were aggregated using random-effects models.
We identified 87 studies, which included 951,083 patients (NCEP: 63 studies, 497,651 patients; rNCEP: 33 studies, 453,432 patients). There was little variation between the cardiovascular risk associated with NCEP and rNCEP definitions. When both definitions were pooled, the metabolic syndrome was associated with an increased risk of cardiovascular disease (CVD) (relative risk [RR]: 2.35; 95% confidence interval [CI]: 2.02 to 2.73), CVD mortality (RR: 2.40; 95% CI: 1.87 to 3.08), all-cause mortality (RR: 1.58; 95% CI: 1.39 to 1.78), myocardial infarction (RR: 1.99; 95% CI: 1.61 to 2.46), and stroke (RR: 2.27; 95% CI: 1.80 to 2.85). Patients with the metabolic syndrome, but without diabetes, maintained a high cardiovascular risk.
The metabolic syndrome is associated with a 2-fold increase in cardiovascular outcomes and a 1.5-fold increase in all-cause mortality. Studies are needed to investigate whether or not the prognostic significance of the metabolic syndrome exceeds the risk associated with the sum of its individual components. Furthermore, studies are needed to elucidate the mechanisms by which the metabolic syndrome increases cardiovascular risk.

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Available from: Salvatore Mottillo, Oct 07, 2014
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    • "of MS is increased in obesity [11] and is associated with atherothrombotic complications in micro-and macrovascular territories [12] [13]. The syndrome is also strongly associated with the increased risk of coronary heart disease and type 2 diabetes mellitus (T2DM) [14] [15] [16] [17]. The abnormal metabolic state that accompanies diabetes causes arterial dysfunction. "
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    ABSTRACT: Background Lipid accumulation product (LAP) has been advocated as a simple clinical indicator of metabolic syndrome (MS). However, no studies have evaluated the accuracy of LAP in predicting MS in Taiwanese adults. The aim of our investigation was to use LAP to predict MS in Taiwanese adults. Methods Taiwanese adults aged 50 years and over (n = 513) were recruited from a physical examination center at a regional hospital in southern Taiwan. MS was defined according to the MS criteria for Taiwanese people. LAP was calculated as (waist circumference [cm] − 65) × (triglyceride concentration [mM]) for men, and (waist circumference [cm] − 58) × (triglyceride concentration [mM]) for women. Simple logistic regression and receiver-operating characteristic (ROC) analyses were conducted. Results The prevalence of MS was 19.5 and 21.5% for males and females, respectively. LAP showed the highest prediction accuracy among adiposity measures with an area under the ROC curve (AUC) of 0.901. This was significantly higher than the adiposity measure of waist-to-height ratio (AUC = 0.813). Conclusions LAP was a simple and accurate predictor of MS in Taiwanese people aged 50 years and over. LAP had significantly higher predictability than other adiposity measures tested.
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