title: Metabolic syndrome and cardiovascular disease in older people: The cardiovascular health study.
abstract: OBJECTIVE
  To assess the prospective association between metabolic syndrome (MetS) and cardiovascular disease (CVD) in older people and to evaluate the effect of lowering the threshold for impaired fasting glucose (IFG) on the prevalence of IFG and MetS and the risk of CVD.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Four field centers in U.S. communities.
  
  
  METHODS
  Three thousand five hundred eighty-five subjects in the Cardiovascular Health Study free of diabetes mellitus and CVD at baseline (mean age 72, 62% female, 14% black).
  
  
  METHODS
  Baseline measures of MetS components and adjudicated incident CVD events. MetS (2001) was defined first using the original criteria from the Third Adult Treatment Panel Report of the National Cholesterol Education Program (> or =3 of the following: large waist circumference (women >88 cm, men >102 cm), elevated triglycerides (> or =1.70 mmol/L), low high-density lipoprotein cholesterol (men <1.04 mmol/L, women <1.30 mmol/L), elevated fasting glucose (6.1-6.9 mmol/L), and high blood pressure (> or =130/85 mmHg or self-reported use of medications for hypertension). Subjects were also classified according to the revised definition of the MetS (2005) that applies the lower threshold for fasting glucose (5.6-6.9 mmol/L).
  
  
  RESULTS
  During follow-up (median 11 years), 818 coronary heart disease (CHD), 401 stroke, and 554 congestive heart failure (CHF) events occurred. Age- and race-adjusted hazard ratios (HRs) for CHD, stroke, and CHF were 1.30 (95% confidence interval (CI) = 1.07-1.57), 0.94 (95% CI = 0.73-1.21), and 1.40 (95% CI = 1.12-1.76) for women and 1.35 (95% CI = 1.10-1.66), 1.51 (95% CI = 1.08-2.12), and 1.47 (95% CI = 1.14-1.90) for men, respectively. Overall, women and men with MetS (2005) were 20% to 30% more likely to experience any CVD event than subjects without MetS (2005). Using the lower cut-point for IFG resulted in a near tripling in IFG prevalence (16% to 46%) and an additional 9% classified with MetS (2005) but HRs similar to those estimated from the original MetS (2001) criteria. High blood pressure was the component most strongly associated with incident CHD.
  
  
  CONCLUSIONS
  Results from this study of an elderly, population-based cohort provide support for earlier investigations in primarily middle-aged populations that link the presence of MetS with the development of CVD and further underscore the importance of recognizing and treating its individual components, particularly high blood pressure.
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina 27514, USA. am_mcneill@alumni.unc.edu
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: McNeill
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Girman
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.forename: Lynne E
authors.initials: LE
authors.lastname: Wagenknecht
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Barzilay
authors.forename: Russell P
authors.initials: RP
authors.lastname: Tracy
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Savage
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Jackson
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology*; D015331:Cohort Studies; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications*; D012307:Risk Factors; D012737:Sex Factors; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D001786:Blood Glucose