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: 16.5). 09/2010; 56(14):1113-32. DOI: 10.1016/j.jacc.2010.05.034
Source: PubMed


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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    • "The metabolic syndrome (MetS) is a composite of central obesity, hyperglycemia/insulin resistance (IR), dyslipidemia and hypertension that is highly prevalent worldwide [1]. MetS is also associated with all-cause mortality, myocardial infarction, and stroke in subjects with and without diabetes [2]. Interestingly, current evidence shows that metabolically unhealthy normal-weight individuals have similar mortality and cardiovascular disease risk compared with metabolically unhealthy overweight or obese persons [3] [4]. "
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    ABSTRACT: Context and objective: We examined whether a prevalent caveolin-1 gene (CAV1) variant, previously related to insulin resistance, is associated with metabolic syndrome (MetS). Patients and methods: We included subjects genotyped for the CAV1 variant rs926198 from two cohorts: 735 Caucasians from the HyperPATH multicenter study, and 810 Hispanic participants from the HTN-IR cohort. Results: Minor allele carriers from HyperPATH cohort (57% of subjects) had higher Framingham risk scores, higher odds of diabetes (10.7% vs 5.7%, p=0.016), insulin resistance (44.3% vs 35.1%, p=0.022), low HDL (49.3% vs 39.6%, p=0.018) and MetS (33% vs 20.5%, p<0.001) but similar BMI. Consistently, minor allele carriers exhibited higher odds of MetS, even when adjusted for confounders and relatedness (OR 2.83 (1.73-4.63), p<0.001). The association with MetS was replicated in the Hispanic cohort HTN-IR (OR 1.61, [1.06-2.44], p=0.025). Exploratory analyses suggest that MetS risk is modified by a CAV1 variant-BMI status interaction, whereby the minor allele carrier status strongly predicted MetS (OR 3.86 [2.05-7.27], p<0.001) and diabetes (OR 2.27 [1.07-4.78], p=0.03) in non-obese, but not in obese subjects. In addition, we observed a familial aggregation for MetS diagnosis in minor allele carriers. Conclusion: The prevalent CAV1 gene variant rs926198 is associated with MetS in separate Caucasian and Hispanic cohorts. These findings appear to be driven by an interaction between the genetic marker and obesity status, suggesting that the CAV1 variant may improve risk profiling in non-obese subjects. Additional studies are needed to confirm the clinical implications of our results.
    Metabolism: clinical and experimental 10/2015; DOI:10.1016/j.metabol.2015.09.005 · 3.89 Impact Factor
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    • "Metabolic syndrome and its risk factors like hyperglycaemia, dyslipidaemia, hypertension and obesity are leading cause of mortality and morbidity in low-mid income countries [1]. It is associated with a 2-fold increase in risk for cardiovascular diseases (CVD) and associated mortality as well as a 1.5-fold increase in risk for all-cause mortality [2]. Ongoing lifestyle changes of urbanization are enhancing the rate of physical inactivity and unhealthy diets have been implicated as a contributory factor to the epidemiological transition of metabolic syndrome and related risks in low-middle income countries [3] [4]. "
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    ABSTRACT: Physical activity is an essential determinant of health. However, there is dearth of evidence regarding prevalence of physical activity in developing countries, especially its association with metabolic syndrome risk factors. This study assessed the association of physical activity with metabolic syndrome in a Nigerian population. A cross-sectional study was carried out on apparently healthy persons who are ≥18 years old. The World Health Organisation (WHO) Global Physical Activity Questionnaire (GPAQ) was used to collect five domains of physical activity. Participants were classified as physically active or inactive based on meeting the cut-off value of 600 MET-min/week. Metabolic syndrome was diagnosed using the Joint Scientific Statement on Harmonizing the Metabolic Syndrome criteria. Overall prevalence of physically active individuals was 50.1% (CI: 45.6-54.7%). Physical inactivity is significantly more in females (p<0.01) and among participants >40 years old (p<0.0001). Whereas individuals with metabolic syndrome appeared more likely to be physically active (OR=1.48, CI: 0.71-3.09); physical inactivity showed to exist more among participants who were living in urban area (OR=6.61, CI: 3.40-12.85, p<0.001). Participants with prediabetes (OR=1.69, CI: 0.62-4.61) and diabetes (OR=1.91, CI: 0.65-5.63) were more likely to be physically inactive as compared to other metabolic syndrome risk factors. The high prevalence of physical inactivity in this study population is a clear indication that concerted efforts to improve physical activity may be required. However, it seems that metabolic syndrome is not improved by being physically active. This suggests that interventions directed at physical activity alone may not produce optimal efficacy in this study population. Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.
    Diabetes and Metabolic Syndrome Clinical Research and Reviews 08/2015; DOI:10.1016/j.dsx.2015.08.010
    • " suffer from severe mental illnesses ( Bartoli et al . , 2013a , b ; De Hert et al . , 2011 ; Mitchell et al . , 2013 ) . Individuals with SD have a much higher chance , relative to general population but also to SCZ / ONAP , of suffering from comorbid MetS , that represents an important risk factor ( Galassi et al . , 2006 ; Gami et al . , 2007 ; Mottillo et al . , 2010 ; Wu et al . , 2010 ) at least partially explaining the excess mortality among SD patients ( Capasso et al . , 2008 ; Laursen et al . , 2007 ) . The assessment of relevant clinical parameters should be part of regular screening for people with SD , with long - term monitoring of lifestyle habits , dietary patterns , blood pressure , and"
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    ABSTRACT: People with psychotic disorders, including schizophrenia (SCZ), schizoaffective disorder (SD), or other non-affective psychoses (ONAP), have a higher risk of metabolic syndrome (MetS) than general population. However, previous meta-analyses failed to explore if people with SD are more likely to suffer from MetS than SCZ and ONAP. We carried out a systematic review and meta-analysis comparing rates of MetS in SD with those in SCZ or ONAP. We searched main electronic databases for relevant articles published up to January 2015, and for unpublished data, contacting corresponding authors, to minimize selective reporting bias. Odds ratios (ORs) based on random effects models, with 95% confidence intervals (CIs), and heterogeneity (I2), were estimated. We performed leave-one-out, quality-based, and subgroups analyses to check findings validity. Testing for publication bias, Egger's test estimates were reported. We included 7,616 individuals (1,632 with SD and 5,984 with SCZ/ONAP) from 30 independent samples. SD, as compared with SCZ/ONAP, had a random-effect pooled OR (95%CI) for MetS of 1.41 (1.23-1.61; p<0.001; I2 = 5%). No risk of publication bias was found (p=0.85). Leave-one-out, sensitivity, and subgroups analyses confirmed the association. To our knowledge, this is the first meta-analysis comparing MetS comorbidity between individuals with SD and those with SCZ or ONAP. SD subjects are more likely to suffer from MetS, with consistent findings across the studies included. However, the role of explanatory factors of this association, and the relative contribution of MetS subcomponents, deserve further research.
    Journal of Psychiatric Research 05/2015; 66-67:127-134. DOI:10.1016/j.jpsychires.2015.04.028 · 3.96 Impact Factor
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