title: The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study.
abstract: OBJECTIVE
  To assess the magnitude of the association between the National Cholesterol Education Program's Third Adult Treatment Panel Report (ATP III) definition of the metabolic syndrome and cardiovascular disease (CVD).
  
  
  METHODS
  Cox regression was used to estimate the relative risk of incident coronary heart disease (CHD) and stroke among 12,089 black and white middle-aged individuals in the Atherosclerosis Risk in Communities (ARIC) study.
  
  
  RESULTS
  The metabolic syndrome was present in approximately 23% of individuals without diabetes or prevalent CVD at baseline. Over an average of 11 years of follow-up, 879 incident CHD and 216 ischemic stroke events occurred. Among the components of the metabolic syndrome, elevated blood pressure and low levels of HDL cholesterol exhibited the strongest associations with CHD. Men and women with the metabolic syndrome were approximately 1.5 and 2 times more likely to develop CHD than control subjects after adjustment for age, smoking, LDL cholesterol, and race/ARIC center (sex interaction P < 0.03). Similar associations were found between the metabolic syndrome and incident ischemic stroke. Comparison of receiver operating characteristic curves indicated that the metabolic syndrome did not materially improve CHD risk prediction beyond the level achieved by the Framingham Risk Score (FRS).
  
  
  CONCLUSIONS
  Individuals without diabetes or CVD, but with the metabolic syndrome, were at increased risk for long-term cardiovascular outcomes, although statistical models suggested that most of that risk was accounted for by the FRS. Nevertheless, identification of individuals with the metabolic syndrome may provide opportunities to intervene earlier in the development of shared disease pathways that predispose individuals to both CVD and diabetes.
authors.affiliation: University of North Carolina, Chapel Hill, 137 E. Franklin St, Chapel Hill, NC 28514, USA. wayne_rosamond@unc.edu
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: McNeill
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Girman
authors.forename: Sherita Hill
authors.initials: SH
authors.lastname: Golden
authors.forename: Maria I
authors.initials: MI
authors.lastname: Schmidt
authors.forename: Honey E
authors.initials: HE
authors.lastname: East
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
mesh_terms: D001161:Arteriosclerosis / Q000453:epidemiology*; D044383:Black People / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D044465:White People / Q000706:statistics & numerical data