title: 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.
abstract: BACKGROUND
  The National Cholesterol Education Program (NCEP) recently proposed a simple definition for metabolic syndrome. Information on the prospective association of this definition for coronary heart disease (CHD) and type 2 diabetes is currently limited.
  
  
  RESULTS
  We used a modified NCEP definition with body mass index in place of waist circumference. Baseline assessments in the West of Scotland Coronary Prevention Study were available for 6447 men to predict CHD risk and for 5974 men to predict incident diabetes over 4.9 years of follow-up. Mean LDL cholesterol was similar but C-reactive protein was higher (P<0.0001) in the 26% of men with the syndrome compared with those without. Metabolic syndrome increased the risk for a CHD event [univariate hazard ratio (HR)=1.76 (95% CI, 1.44 to 2.15)] and for diabetes [univariate HR=3.50 (95% CI 2.51 to 4.90)]. Metabolic syndrome continued to predict CHD events (HR=1.30, 95% CI, 1.00 to 1.67, P=0.045) in a multivariate model incorporating conventional risk factors. Men with 4 or 5 features of the syndrome had a 3.7-fold increase in risk for CHD and a 24.5-fold increase for diabetes compared with men with none (both P<0.0001). C-reactive protein enhanced prognostic information for both outcomes. With pravastatin, men with the syndrome had similar risk reduction for CHD as compared with those without (HR, 0.73 and 0.69; pravastatin versus placebo).
  
  
  CONCLUSIONS
  A modified NCEP metabolic syndrome definition predicts CHD events, and, more strikingly, new-onset diabetes, and thus helps identify individuals who may receive particular benefit from lifestyle measures to prevent these diseases.
authors.affiliation: University Department of Pathological Biochemistry, Glasgow Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, Scotland, UK. nsattar@clinmed.gla.ac.uk
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: Allan
authors.initials: A
authors.lastname: Gaw
authors.forename: Olga
authors.initials: O
authors.lastname: Scherbakova
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.forename: Denis St J
authors.initials: DS
authors.lastname: O'Reilly
authors.forename: Steven M
authors.initials: SM
authors.lastname: Haffner
authors.forename: Chris
authors.initials: C
authors.lastname: Isles
authors.forename: Peter W
authors.initials: PW
authors.lastname: Macfarlane
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Packard
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Cobbe
authors.forename: James
authors.initials: J
authors.lastname: Shepherd
mesh_terms: D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology* / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology; D017035:Pravastatin / Q000008:administration & dosage; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012606:Scotland / Q000453:epidemiology; D014280:Triglycerides / Q000097:blood
chemical_list: D014280:Triglycerides; D002097:C-Reactive Protein; D017035:Pravastatin