title: Metabolic syndrome and mortality in the elderly: a time-dependent association.
abstract: OBJECTIVE
  To evaluate the association between metabolic syndrome (MetS) components and mortality over time.
  
  
  METHODS
  3086 residents aged ≥49 years were followed in the Blue Mountains Eye Study, Australia. MetS components as defined by the International Diabetes Federation criteria were measured at baseline (1992-1994), 5-year (1997-1999) and 10-year (2002-2004). Using Cox proportional hazards and competing risks models with MetS as a time-dependent covariate, we estimated the effects of MetS on all-cause and cause-specific mortality. Time-dependent receiver-operating-characteristic curve, integrated-discrimination-improvement and net-reclassification-improvement tests assessed predicting abilities of individual and combined MetS components.
  
  
  RESULTS
  Effect of MetS on mortality increased with time: all cause: 2-year: adjusted hazard ratio 0.96 [95% confidence interval 0.69-1.34]; 5-year: 1.06 [0.84-1.32]; 10-year: 1.23 [1.01-1.51]; and CHD: 2-year: 0.46 [0.20-1.03]; 5-year: 0.70 [0.41-1.21]; 10-year: 1.62 [1.02-2.59]. Conversely, MetS was associated with an increased risk of cancer death at 2-year only: 1.62 [1.01-2.62]; but not 5-year: 1.30 [0.94-1.81] or 10-year: 0.90 [0.57-1.44]. The discrimination analyses showed that different MetS components were associated with different causes of death.
  
  
  CONCLUSIONS
  The long-term effect of MetS on all-cause and CHD mortality in an older population was detected using time-dependent models while simulating the real scenarios of MetS changes over time.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
authors.forename: Haleh
authors.initials: H
authors.lastname: Ghaem Maralani
authors.forename: Bee Choo
authors.initials: BC
authors.lastname: Tai
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
authors.forename: Jialiang
authors.initials: J
authors.lastname: Li
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000453:epidemiology* / Q000401:mortality*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors