Metabolic syndrome and diabetes, alone and in combination, as predictors of cardiovascular disease mortality among men.
OBJECTIVE
To examine cardiovascular disease (CVD) mortality risk in men with diabetes only, metabolic syndrome only, and concurrent metabolic syndrome and diabetes.


METHODS
We examined CVD mortality risk by metabolic syndrome and diabetes status in men from the Aerobics Center Longitudinal Study (ACLS) (mean +/- SD age 45.1 +/- 10.2 years). Participants were categorized as having neither diabetes nor metabolic syndrome (n = 23,770), metabolic syndrome only (n = 8,780), diabetes only (n = 532), or both (n = 1,097). The duration of follow-up was 14.6 +/- 7.0 years with a total of 483,079 person-years of exposure and 1,085 CVD deaths.


RESULTS
Age-, examination year-, and smoking-adjusted CVD death rates (per 1,000 man-years) in men with neither metabolic syndrome nor diabetes, metabolic syndrome only, diabetes only, and both were 1.9, 3.3, 5.5, and 6.5, respectively. CVD mortality was higher in men with metabolic syndrome only (hazard ratio 1.8 [95% CI 1.5-2.0]), diabetes only (2.9 [2.1-4.0]), and both (3.4 [2.8-4.2]) compared with men with neither. The presence of metabolic syndrome was not associated (1.2 [0.8-1.7]) with higher CVD mortality risk in individuals with diabetes. In contrast, the presence of diabetes substantially increased (2.1 [1.7-2.6]) CVD mortality risk in individuals with metabolic syndrome.


CONCLUSIONS
The presence of diabetes was associated with a threefold higher CVD mortality risk, and metabolic syndrome status did not modify this risk. Our findings support the fact that physicians should be aggressive in using CVD risk-reducing therapies in all diabetic patients regardless of metabolic syndrome status.
Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA. tim.church@pbrc.edu
Timothy S
TS
Church
Angela M
AM
Thompson
Peter T
PT
Katzmarzyk
Xuemei
X
Sui
Neil
N
Johannsen
Conrad P
CP
Earnest
Steven N
SN
Blair
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D048909:Diabetes Complications / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000401:mortality*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011634:Public Health; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013781:Texas; D014481:United States / Q000453:epidemiology; D055815:Young Adult