National Cholesterol Education Program versus World Health Organization metabolic syndrome in relation to all-cause and cardiovascular mortality in the San Antonio Heart Study.
BACKGROUND
To assess the utility of clinical definitions of the metabolic syndrome (MetS) to identify individuals with increased cardiovascular risk, we examined the relation between the MetS, using both the National Cholesterol Education Program (NCEP) and the World Health Organization definitions, and all-cause and cardiovascular mortality in San Antonio Heart Study participants enrolled between 1984 and 1988.


RESULTS
Among 2815 participants, 25 to 64 years of age at enrollment, 509 met both criteria, 197 met NCEP criteria only, and 199 met WHO criteria only. Over an average of 12.7 years, 229 deaths occurred (117 from cardiovascular disease). Moreover, in the primary prevention population of 2372 participants (ie, those without diabetes or cardiovascular disease at baseline), 132 deaths occurred (50 from cardiovascular disease). In the primary prevention population, the only significant association adjusted for age, gender, and ethnic group was between NCEP-MetS and cardiovascular mortality (hazard ratio [HR], 2.01; 95% CI, 1.13-3.57). In the general population, all-cause mortality HRs were 1.47 (95% CI, 1.13-1.92) for NCEP-MetS and 1.27 (95% CI, 0.97-1.66) for WHO-MetS. Furthermore, for cardiovascular mortality, there was evidence that gender modified the predictive ability of the MetS. For women and men, respectively, HRs for NCEP-MetS were 4.65 (95% CI, 2.35-9.21) and 1.82 (95% CI, 1.14-2.91), whereas HRs for WHO-MetS were 2.83 (95% CI, 1.55-5.17) and 1.15 (95% CI, 0.72-1.86).


CONCLUSIONS
In summary, although both definitions were predictive in the general population, the simpler NCEP definition tended to be more predictive in lower-risk subjects.
Department of Medicine, University of Texas Health Science Center at San Antonio, 78229-3900, USA. huntk@uthscsa.edu
Kelly J
KJ
Hunt
Roy G
RG
Resendez
Ken
K
Williams
Steve M
SM
Haffner
Michael P
MP
Stern
D000328:Adult; D000419:Albuminuria / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality*; D015331:Cohort Studies; D015897:Comorbidity; D048909:Diabetes Complications / Q000401:mortality; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology; D006946:Hyperinsulinism / Q000453:epidemiology; D006949:Hyperlipidemias / Q000453:epidemiology; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D017058:Mexican Americans; D008875:Middle Aged; D009026:Mortality; D009313:National Health Programs; D009765:Obesity / Q000453:epidemiology; D010353:Patient Education as Topic; D016016:Proportional Hazards Models; D012307:Risk Factors; D011795:Surveys and Questionnaires; D009626:Terminology as Topic; D013781:Texas / Q000453:epidemiology; D014944:World Health Organization