title: Total and cardiovascular disease mortality predicted by metabolic syndrome is inferior relative to its components.
abstract: OBJECTIVE
  This study examined the predictive role of metabolic syndrome (MetS) and its single components for total and cardiovascular disease (CVD) mortality.
  
  
  METHODS
  We analyzed data from 3,927 participants aged 20-79 years without history of CVD, recruited for the prospective population-based Study of Health in Pomerania (SHIP). During the mean 7.2 years (25 (th), 6.6; 75 (th): 8.0) of follow-up, 240 deaths (79 CVD deaths) occurred. MetS was defined by National Cholesterol Education Program Adult Treatment Panel III guidelines. The association of MetS with total and CVD mortality was analyzed by Cox proportional hazards regression models. The impact of single MetS components on survival time was compared using standardized beta coefficients from multivariable linear regression models.
  
  
  RESULTS
  Baseline MetS prevalence was 28.8%. Age- and gender-adjusted Cox models revealed that participants with MetS had an increased risk of total mortality (hazard ratio (HR) 1.41; 95% confidence interval (95% CI) 1.09-1.82) and CVD mortality (HR 1.82; 95% CI 1.22-3.13) compared to participants without MetS. Of the single MetS components, participants with increased waist circumference (WC) and glucose levels exposed highest risk of total (HR 1.49; 95% CI 1.10-2.01; HR 2.13; 95% CI 1.58-2.90, respectively) and CVD mortality (HR 2.02; 95% CI 1.13-3.61; HR 3.15; 95% CI 1.94-5.11, respectively). Increasing WC or glucose by 1 standard deviation (SD) significantly decreased age- and gender-adjusted beta coefficients for survival time by 0.09, and 0.08 SD, respectively.
  
  
  CONCLUSIONS
  There was no added predictive value of MetS beyond its individual components with respect to mortality risk. Attention should be redirected to the individual components, particularly visceral obesity and high glucose, to treat each abnormality appropriately.
authors.affiliation: Institute for Community Medicine, Ernst Moritz Arndt University Greifswald, Germany. robin.haring@uni-greifswald.de
authors.forename: R
authors.initials: R
authors.lastname: Haring
authors.forename: H
authors.initials: H
authors.lastname: Wallaschofski
authors.forename: M
authors.initials: M
authors.lastname: Nauck
authors.forename: S B
authors.initials: SB
authors.lastname: Felix
authors.forename: C O
authors.initials: CO
authors.lastname: Schmidt
authors.forename: M
authors.initials: M
authors.lastname: Dörr
authors.forename: S
authors.initials: S
authors.lastname: Sauer
authors.forename: G
authors.initials: G
authors.lastname: Wilmking
authors.forename: H
authors.initials: H
authors.lastname: Völzke
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000503:physiopathology; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000209:etiology; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis; D055105:Waist Circumference; D055815:Young Adult