title: Metabolic syndrome and early-onset coronary artery disease: is the whole greater than its parts?
abstract: OBJECTIVE
  We sought to examine the association between the metabolic syndrome (MetS) (defined both by the 2001 National Cholesterol Educational Program Adult Treatment Panel III [ATP-III] definition and the American Heart Association/National Heart, Lung and Blood Institute [AHA/NHLBI] revision incorporating the lower threshold for impaired fasting glucose [IFG]) and early-onset coronary artery disease (CAD).
  
  
  BACKGROUND
  The impact of MetS on premature CAD has not been studied extensively. Lowering the threshold to define the IFG component (from 110 to 100 mg/dl) and the value of the syndrome as a whole versus its individual components are subjects of intense debate.
  
  
  METHODS
  We performed a case-control study with 393 early-onset CAD subjects (acute myocardial infarction, angina with > or =50% stenosis, or coronary revascularization) in men under age 46 years or women under age 56 years and 393 control subjects individually matched for gender, age, and race/ethnicity.
  
  
  RESULTS
  By conditional logistic regression, presence of ATP-III MetS without diabetes (adjusted odds ratio [adj-OR] 4.9; 95% confidence interval [CI] 3.4 to 8.0) and with diabetes (adj-OR 8.0, 95% CI 4.39 to 14.6) was a strong independent determinant of early-onset CAD. Using the AHA/NHLBI revision, these ORs became slightly stronger. However, neither definition of MetS remained significantly associated with early-onset CAD in multivariate models adjusting for individual components.
  
  
  CONCLUSIONS
  The presence of MetS imparts a high risk of early-onset clinical CAD, but the prognostic information associated with the syndrome is not greater than the sum of its parts.
authors.affiliation: Kaiser Permanente Division of Research, Oakland, California 94612, USA. cgi@dor.kaiser.org
authors.forename: Carlos
authors.initials: C
authors.lastname: Iribarren
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.forename: Gail
authors.initials: G
authors.lastname: Husson
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
authors.forename: Joan M
authors.initials: JM
authors.lastname: Fair
authors.forename: Thomas
authors.initials: T
authors.lastname: Quertermous
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Fortmann
mesh_terms: D000328:Adult; D017668:Age of Onset; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000453:epidemiology*; D008875:Middle Aged; D012307:Risk Factors