title: Metabolic syndrome, its preeminent clusters, incident coronary heart disease and all-cause mortality--results of prospective analysis for the Atherosclerosis Risk in Communities study.
abstract: OBJECTIVE
  To investigate the prospective association between Metabolic Syndrome (MetS) and coronary heart disease (CHD) and all-cause mortality.
  
  
  METHODS
  A bi-racial cohort of 14 699 middle-aged Americans from the Atherosclerosis Risk in Communities study were followed for the development of new CHD and death over a period of 9 years. MetS, using the original ATP-III criteria, was defined as having at least three of the following components: elevated blood pressure (BP), elevated plasma glucose, elevated blood triglyceride (TG), increased waist circumference, and low HDL cholesterol (HDL-c). Incident CHD cases included hospitalized myocardial infarction (MI), fatal CHD, revascularization procedures, and silent MI as detected by EKG.
  
  
  RESULTS
  The prevalence of the MetS at baseline was 29%, 30%, 40% and 26% among CHD-free white women, white men, black women, and black men, respectively. There were 1018 incident CHD cases and 1039 deaths. The relative risk (RR) and 95% confidence interval (CI) of incident CHD associated with MetS was 2.46 (1.99, 3.03) for women and 1.86 (1.59, 2.18) for men. Clear dose-response relationship between the number of MetS components and incidence of CHD was found (P for linear trend <0.001). The following three clusters of MetS components posed the highest risk for CHD: (i) the elevated BP and glucose and low HDL-c group [RR = 5.68 (3.44, 9.37)]; (ii) the elevated BP and glucose and TG group [RR = 5.08 (2.96, 8.70)]; and (iii) the elevated BP and TG and low HDL-c group [RR = 3.98 (2.75, 5.77)]. When all five components co-existed, the risk was the highest [RR = 6.24 (4.65, 8.36)]. Similar results with attenuated RR were found for all-cause mortality.
  
  
  CONCLUSIONS
  Individuals, especially women, with the MetS have significantly higher risk of developing CHD. The riskiest combination is high-BP and glucose clustered with low HDL-c or high TG. These data highlight the importance of targeting MetS in the prevention of CHD and premature death.
authors.affiliation: Department of Health Evaluation Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA. yhong@psu.edu
authors.forename: Y
authors.initials: Y
authors.lastname: Hong
authors.forename: X
authors.initials: X
authors.lastname: Jin
authors.forename: J
authors.initials: J
authors.lastname: Mo
authors.forename: H-M
authors.initials: HM
authors.lastname: Lin
authors.forename: Y
authors.initials: Y
authors.lastname: Duan
authors.forename: M
authors.initials: M
authors.lastname: Pu
authors.forename: D L
authors.initials: DL
authors.lastname: Wolbrette
authors.forename: D
authors.initials: D
authors.lastname: Liao
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D001824:Body Constitution; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology*; D008875:Middle Aged; D014481:United States / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D008055:Lipids