title: The metabolic syndrome: a critical appraisal based on the CUORE epidemiologic study.
abstract: OBJECTIVE
  Multiple aspects of the metabolic syndrome (MetS) remain problematic. Here we assess the association between epidemic obesity and the other MetS traits, and MetS utility for cardiovascular disease (CVD) risk assessment.
  
  
  METHODS
  Italian population-based Progetto CUORE data were used: 17 252 women and men ages 35-69 years, baseline 1984-1993, mean follow-up of 10 years, for nonfatal plus fatal CVD events. NCEP-ATP III criteria defined MetS.
  
  
  RESULTS
  Epidemic obesity was strongly related to epidemic rates of the four other MetS traits. Only four of 16 possible MetS trait combinations were common; their CVD hazard ratios ranged from 1.21 to 1.70. In multivariate analyses MetS was no better than the sum of its parts in predicting CVD, important information was lost due to omission of non-HDL-C and smoking, and from considering MetS traits as yes/no variables. CVD risk prediction by MetS was less strong for men and no stronger for women than by classical risk factors (blood pressure, diabetes, serum cholesterol, smoking, overweight/obesity).
  
  
  CONCLUSIONS
  These findings are concordant with the inference that epidemic obesity importantly influences epidemic occurrence of the other MetS traits; they also indicate that use of MetS for CVD risk assessment has limitations and needs critical reconsideration.
authors.affiliation: Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Viale Regina Elena, Rome, Italy. simona.giampaoli@iss.it
authors.forename: Simona
authors.initials: S
authors.lastname: Giampaoli
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Stamler
authors.forename: Chiara
authors.initials: C
authors.lastname: Donfrancesco
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.forename: Diego
authors.initials: D
authors.lastname: Vanuzzo
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Cesana
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Lorenza
authors.initials: L
authors.lastname: Pilotto
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.forename: Luigi
authors.initials: L
authors.lastname: Palmieri