title: Increased Cardiovascular Mortality in Subjects With Metabolic Syndrome Is Largely Attributable to Diabetes and Hypertension in 159,971 Korean Adults.
abstract: BACKGROUND
  Metabolic syndrome (MetS) is a risk factor for cardiovascular disease (CVD) mortality.
  
  
  OBJECTIVE
  This study aimed to evaluate the association of MetS with all-cause and cardiovascular mortality in apparently healthy young Korean subjects.
  
  
  METHODS
  A retrospective study of 155,971 participants (mean age, 41.8 y) in a health screening program, followed up for 3.7 years (597,628.2 person-years). The risk for all-cause mortality and CVD mortality were analyzed according to the presence or absence of MetS.
  
  
  RESULTS
  A total of 542 subjects died during followup. Women with MetS showed a significantly increased age-adjusted hazard ratio (HR) for all-cause mortality compared with women without MetS, even after adjustment for confounding factors (HR, 1.82; 95% confidence interval [CI], 1.15-2.88). Subjects with MetS showed a significantly increased risk for CVD mortality compared with those without MetS, even after adjustment for confounding factors (HR, 1.60; 95% CI, 1.02-2.20), of which significance disappeared when subjects with diabetes or hypertension at baseline were excluded from the analysis (HR, 0.95; 95% CI, 0.29-3.12).
  
  
  CONCLUSIONS
  The presence of MetS increased the risk for all-cause mortality in women and the risk for CVD mortality in total population. These increased HR attributed to the pre-existing diabetes or hypertension in this population.
authors.affiliation: Department of Cardiology (K.-C.S., B.-J.K., B.-S.K.), Department of Endocrinology and Metabolism (E.-J.R., W.-Y.L., K.-W.O., S.-W.P.), Department of Occupational and Environmental Medicine (S.R.), Department of Neurology (P.W.-C.), and Department of Nephrology (H.K., K.-B.L.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and Human Development and Health Academic Unit (C.D.B.), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Ki-Chul
authors.initials: KC
authors.lastname: Sung
authors.affiliation: Department of Cardiology (K.-C.S., B.-J.K., B.-S.K.), Department of Endocrinology and Metabolism (E.-J.R., W.-Y.L., K.-W.O., S.-W.P.), Department of Occupational and Environmental Medicine (S.R.), Department of Neurology (P.W.-C.), and Department of Nephrology (H.K., K.-B.L.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and Human Development and Health Academic Unit (C.D.B.), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Eun-Jung
authors.initials: EJ
authors.lastname: Rhee
authors.affiliation: Department of Cardiology (K.-C.S., B.-J.K., B.-S.K.), Department of Endocrinology and Metabolism (E.-J.R., W.-Y.L., K.-W.O., S.-W.P.), Department of Occupational and Environmental Medicine (S.R.), Department of Neurology (P.W.-C.), and Department of Nephrology (H.K., K.-B.L.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and Human Development and Health Academic Unit (C.D.B.), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Seungho
authors.initials: S
authors.lastname: Ryu
authors.affiliation: Department of Cardiology (K.-C.S., B.-J.K., B.-S.K.), Department of Endocrinology and Metabolism (E.-J.R., W.-Y.L., K.-W.O., S.-W.P.), Department of Occupational and Environmental Medicine (S.R.), Department of Neurology (P.W.-C.), and Department of Nephrology (H.K., K.-B.L.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and Human Development and Health Academic Unit (C.D.B.), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Byung-Jin
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Cardiology (K.-C.S., B.-J.K., B.-S.K.), Department of Endocrinology and Metabolism (E.-J.R., W.-Y.L., K.-W.O., S.-W.P.), Department of Occupational and Environmental Medicine (S.R.), Department of Neurology (P.W.-C.), and Department of Nephrology (H.K., K.-B.L.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and Human Development and Health Academic Unit (C.D.B.), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Bum-Soo
authors.initials: BS
authors.lastname: Kim
authors.affiliation: Department of Cardiology (K.-C.S., B.-J.K., B.-S.K.), Department of Endocrinology and Metabolism (E.-J.R., W.-Y.L., K.-W.O., S.-W.P.), Department of Occupational and Environmental Medicine (S.R.), Department of Neurology (P.W.-C.), and Department of Nephrology (H.K., K.-B.L.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and Human Development and Health Academic Unit (C.D.B.), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Won-Young
authors.initials: WY
authors.lastname: Lee
authors.affiliation: Department of Cardiology (K.-C.S., B.-J.K., B.-S.K.), Department of Endocrinology and Metabolism (E.-J.R., W.-Y.L., K.-W.O., S.-W.P.), Department of Occupational and Environmental Medicine (S.R.), Department of Neurology (P.W.-C.), and Department of Nephrology (H.K., K.-B.L.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and Human Development and Health Academic Unit (C.D.B.), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Ki-Won
authors.initials: KW
authors.lastname: Oh
authors.affiliation: Department of Cardiology (K.-C.S., B.-J.K., B.-S.K.), Department of Endocrinology and Metabolism (E.-J.R., W.-Y.L., K.-W.O., S.-W.P.), Department of Occupational and Environmental Medicine (S.R.), Department of Neurology (P.W.-C.), and Department of Nephrology (H.K., K.-B.L.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and Human Development and Health Academic Unit (C.D.B.), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Yong Bum
authors.initials: YB
authors.lastname: Kim
authors.affiliation: Department of Cardiology (K.-C.S., B.-J.K., B.-S.K.), Department of Endocrinology and Metabolism (E.-J.R., W.-Y.L., K.-W.O., S.-W.P.), Department of Occupational and Environmental Medicine (S.R.), Department of Neurology (P.W.-C.), and Department of Nephrology (H.K., K.-B.L.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and Human Development and Health Academic Unit (C.D.B.), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Pil-Wook
authors.initials: PW
authors.lastname: Chung
authors.affiliation: Department of Cardiology (K.-C.S., B.-J.K., B.-S.K.), Department of Endocrinology and Metabolism (E.-J.R., W.-Y.L., K.-W.O., S.-W.P.), Department of Occupational and Environmental Medicine (S.R.), Department of Neurology (P.W.-C.), and Department of Nephrology (H.K., K.-B.L.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and Human Development and Health Academic Unit (C.D.B.), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Hyang
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Cardiology (K.-C.S., B.-J.K., B.-S.K.), Department of Endocrinology and Metabolism (E.-J.R., W.-Y.L., K.-W.O., S.-W.P.), Department of Occupational and Environmental Medicine (S.R.), Department of Neurology (P.W.-C.), and Department of Nephrology (H.K., K.-B.L.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and Human Development and Health Academic Unit (C.D.B.), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Byrne
authors.affiliation: Department of Cardiology (K.-C.S., B.-J.K., B.-S.K.), Department of Endocrinology and Metabolism (E.-J.R., W.-Y.L., K.-W.O., S.-W.P.), Department of Occupational and Environmental Medicine (S.R.), Department of Neurology (P.W.-C.), and Department of Nephrology (H.K., K.-B.L.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and Human Development and Health Academic Unit (C.D.B.), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Kyu-Beck
authors.initials: KB
authors.lastname: Lee
authors.affiliation: Department of Cardiology (K.-C.S., B.-J.K., B.-S.K.), Department of Endocrinology and Metabolism (E.-J.R., W.-Y.L., K.-W.O., S.-W.P.), Department of Occupational and Environmental Medicine (S.R.), Department of Neurology (P.W.-C.), and Department of Nephrology (H.K., K.-B.L.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and Human Development and Health Academic Unit (C.D.B.), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Sung-Woo
authors.initials: SW
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality*; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000401:mortality*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000401:mortality*; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies