title: The metabolic syndrome in older individuals: prevalence and prediction of cardiovascular events: the Cardiovascular Health Study.
abstract: OBJECTIVE
  The prevalence of the metabolic syndrome, a potent risk factor for cardiovascular diseases (CVDs), has not been adequately explored in older individuals. Moreover, two sets of criteria have been proposed for the definition of metabolic syndrome, one by the World Health Organization (WHO) and one by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII). We therefore investigated the prevalence of this syndrome in a subgroup of older participants from the Cardiovascular Health Study (CHS) who were free of CVD at baseline. We also compared the prognostic significance of the two definitions of the metabolic syndrome.
  
  
  METHODS
  A total of 2,175 subjects from the CHS who were free of CVD at baseline and not taking antihypertensive or lipid-lowering medications were studied. Prevalence of the metabolic syndrome was assessed with both the WHO and ATPIII criteria. The incidence of coronary or cerebrovascular disease was ascertained during a median follow-up time of 4.1 years.
  
  
  RESULTS
  Prevalence of the metabolic syndrome was 28.1% by ATPIII criteria and 21.0% by WHO criteria. The two sets of criteria provided concordant classification for 80.6% of participants. Multivariate Cox propotional hazard models showed that the metabolic syndrome defined with the ATPIII criteria, but not with the WHO criteria, was an independent predictor of coronary or cerebrovascular events and was associated with a 38% increased risk (hazard ratio 1.38 [95% CI 1.06-1.79], P < 0.01).
  
  
  CONCLUSIONS
  Prevalence of the metabolic syndrome in older individuals is approximately 21-28% (depending on the definition used). The two sets of criteria have 80% concordance in classifying subjects. As defined by the ATPIII criteria, the metabolic syndrome yields independent prognostic information, even after adjusting for traditional cardiovascular risk factors and the individual domains of the metabolic syndrome.
authors.affiliation: Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, 5600 Nathan Shock Dr., Baltimore, MD 21224, USA. scuteria@mail.nih.gov
authors.forename: Angelo
authors.initials: A
authors.lastname: Scuteri
authors.forename: Samer S
authors.initials: SS
authors.lastname: Najjar
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Morrell
authors.forename: Edward G
authors.initials: EG
authors.lastname: Lakatta
mesh_terms: D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D049628:Body Size; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking; D014944:World Health Organization