title: Impact of age and gender on the prevalence and prognostic importance of the metabolic syndrome and its components in Europeans. The MORGAM Prospective Cohort Project.
abstract: OBJECTIVE
  To investigate the influence of age and gender on the prevalence and cardiovascular disease (CVD) risk in Europeans presenting with the Metabolic Syndrome (MetS).
  
  
  METHODS
  Using 36 cohorts from the MORGAM-Project with baseline between 1982-1997, 69094 men and women aged 19-78 years, without known CVD, were included. During 12.2 years of follow-up, 3.7%/2.1% of men/women died due to CVD. The corresponding percentages for fatal and nonfatal coronary heart disease (CHD) and stroke were 8.3/3.8 and 3.1/2.5.
  
  
  RESULTS
  The prevalence of MetS, according to modified definitions of the International Diabetes Federation (IDF) and the revised National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII), increased across age groups for both genders (P<0.0001); with a 5-fold increase in women from ages 19-39 years to 60-78 years (7.4%/7.6% to 35.4%/37.6% for IDF/NCEP-ATPIII) and a 2-fold increase in men (5.3%/10.5% to 11.5%/21.8%). Using multivariate-adjusted Cox regressions, the associations between MetS and all three CVD events were significant (P<0.0001). For IDF/NCEP-ATPIII in men and women, hazard ratio (HR) for CHD was 1.60/1.62 and 1.93/2.03, for CVD mortality 1.73/1.65 and 1.77/2.06, and for stroke 1.51/1.53 and 1.58/1.77. Whereas in men the HRs for CVD events were independent of age (MetS*age, P>0.05), in women the HRs for CHD declined with age (HRs 3.23/3.98 to 1.55/1.56; MetS*age, P=0.01/P=0.001 for IDF/NCEP-ATPIII) while the HRs for stroke tended to increase (HRs 1.31/1.25 to 1.55/1.83; MetS*age, P>0.05).
  
  
  CONCLUSIONS
  In Europeans, both age and gender influenced the prevalence of MetS and its prognostic significance. The present results emphasise the importance of being critical of MetS in its current form as a marker of CVD especially in women, and advocate for a redefinition of MetS taking into account age especially in women.
authors.affiliation: Department of Internal Medicine, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark; Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.
authors.forename: Julie K K
authors.initials: JK
authors.lastname: Vishram
authors.affiliation: Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Borglykke
authors.affiliation: Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.
authors.forename: Anne H
authors.initials: AH
authors.lastname: Andreasen
authors.affiliation: Department of Internal Medicine, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Jeppesen
authors.affiliation: Division of Cardiology, Holbæk University Hospital, Holbæk, Denmark.
authors.forename: Hans
authors.initials: H
authors.lastname: Ibsen
authors.affiliation: Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.
authors.forename: Torben
authors.initials: T
authors.lastname: Jørgensen
authors.affiliation: Cerebro and Cardiovascular Epidemiology Unit, National Centre of Epidemiology Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Palmieri
authors.affiliation: Cerebro and Cardiovascular Epidemiology Unit, National Centre of Epidemiology Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Giampaoli
authors.affiliation: Cerebro and Cardiovascular Epidemiology Unit, National Centre of Epidemiology Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Donfrancesco
authors.affiliation: UKCRC Centre of Excellence for Public Health Research (NI), The Queen's University of Belfast, Belfast, Northern Ireland.
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
authors.affiliation: Clinica Medica e Istituto Auxologico Italiano, Monza, Milano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
authors.affiliation: Research Centre on Public Health, University of Milano Bicocca, Monza, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Cesana
authors.affiliation: National Institute for Health and Welfare (THL), Helsinki, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Kuulasmaa
authors.affiliation: National Institute for Health and Welfare (THL), Helsinki, Finland.
authors.forename: Veikko
authors.initials: V
authors.lastname: Salomaa
authors.affiliation: Department of Health, Barcelona, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Sans
authors.affiliation: Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrieres
authors.affiliation: Institut Pasteur de Lille, Lille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Dallongeville
authors.affiliation: Department of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umeå University, Umeå, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Söderberg
authors.affiliation: Department of Epidemiology and Public Health, University of Strasbourg, Faculty of Medicine, Strasbourg, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Arveiler
authors.affiliation: Department of Epidemiology and Public Health, University of Strasbourg, Faculty of Medicine, Strasbourg, France.
authors.forename: Aline
authors.initials: A
authors.lastname: Wagner
authors.affiliation: Cardiovascular Epidemiology Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom.
authors.forename: Hugh
authors.initials: H
authors.lastname: Tunstall-Pedoe
authors.affiliation: Department of Epidemiology, CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Drygas
authors.affiliation: Department of Endocrinology, Center of Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark, and Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Olsen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult